Chiropractic Care for ADHD

Innate Intelligence and Chiropractic in the Care of Obsessive/Compulsive and Addictive Behaviors

J G Moellendorf, D.C., N.D., L.C.P.  © 2003 JGM

INTRODUCTION

            The philosophy of Chiropractic centers on how Innate Intelligence works through the nervous system for the benefit of the body’s growth and survival.  Persons with the A1 allele of the DRD2 dopamine receptor gene are at great risk of developing obsessive/compulsive and addictive behaviors.  This raises the following questions.  Are these behaviors a form of dis-ease?  Are these behaviors caused by the interference to the flow of mental impulses from Innate Intelligence as it attempts to compensate for a defective gene and the resulting limitations of matter?  Or is Innate Intelligence working perfectly to adapt to the limitations of matter due to a genetic defect?  Or is it merely our perception that determines that these are behavioral problems?  Or is the A1 allele of the DRD2 gene a beneficial adaptation of Innate Intelligence?

            Let’s take a look at the Chiropractic Textbook by Ralph W. Stephenson, D.C., Ph.C. for the definition of what Innate Intelligence is, and what is its purpose.

DEFINITION AND PURPOSE OF INNATE INTELLIGENCE

            The following principles are quoted from Stephenson’s 33 Principles of Chiropractic.  His notable opus is based on the philosophy, teachings, and writings of Chiropractic’s founder, D. D. Palmer, D.C. and D. D.’s son and developer of Chiropractic, B. J. Palmer, D.C., Ph.C.

Principle Number 20.  Innate Intelligence.  A “living thing” has an inborn intelligence within its body, called Innate Intelligence.

            As Stephenson says, “It is the local intelligence which has built a house for itself and keeps that house in repair, and is the intelligence to which the condition of the structure is of supreme importance….The cells and the bodies are built according to a plan.  It takes an infinitely wise Architect to make those plans.”  [Stephenson 1927, 257]  All of the structures and functions of the body are under the guardianship and care of Innate Intelligence for the body’s self-preservation in the best way possible.

Principle Number 21.  The Mission of Innate Intelligence.  The mission of Innate Intelligence is to maintain the material of the body of a “living thing” in active organization.

            “It is the ambition of Innate Intelligence to build the body and then keep it actively organic….(The) universe could not be complete with only unadapted forces and universal laws of the destructive kind.  In order to complete the cycle, there must be construction.”  [Stephenson 1927, 258]  Left to itself, everything in the universe regresses from a state of higher organization and order to a state of lower organization and finally chaos.  This is known as the Law of Entropy.  Higher organization in the universe can only be accomplished by an application of intelligence.  Innate Intelligence employs the forces of the universe to construct, maintain, and preserve the body in a highly organized, organic state as best as it is capable with what it has available to work with.

Principle Number 23.  The Function of Innate Intelligence.  The function of Innate Intelligence is to adapt universal forces and matter for use in the body, so that all parts of the body will have co-ordinated action for mutual benefit.

            “Innate Intelligence, the law of organization, continually co-ordinates the forces and materials within the organism to keep it actively organized.  That is to say, creating….Innate takes elements of no adaptive character, puts them together, ‘investing with new character,’ and now a new structure is brought into being, and is so maintained.

            “Nothing less than intelligence could do this.  It is all accomplished, not by creating new forces and matter ‘out of nothing,’ but ‘investing’ what is already existing with new character.  Thus the natural energies within the body are assembled and made to do the work of organization.”  [Stephenson 1927, 262]

            Innate Intelligence performs whatever is necessary to construct, maintain, and preserve the body in as highly organized and active a state as possible by organizing, adapting, and coordinating the materials and forces at its disposal, without our consciously attending to these vital matters.

Principle Number 24.   The Limits of Adaptation.  Innate Intelligence adapts forces and matter for the body as long as it can do so without breaking a universal law, or Innate Intelligence is limited by the limitations of matter.

            “Adaptation of matter can only be to the point where molecules and atoms must obey physical and chemical laws.  Innate can manage these laws up to a certain point by manipulation, but cannot change or destroy them.  She can only use them to the limits of matter….Should Innate fail in these adaptations for any cause, these forces will injure or destroy her tissues.”  [Stephenson 1927, 263]

            Innate Intelligence can only work within universal law.  It uses universal forces and universal matter as best as it is able for the benefit of the body, without breaking universal law.  When a needed material is not available, Innate Intelligence will attempt to locate it, or adapt in another way to preserve the body.  Universal forces will injure or destroy the body’s cells when Innate Intelligence is not able to make a full adaptation.  This becomes a matter of survival for the body.  Because of the limitations of matter, materials or forces may be used to accomplish short-term survival, even though this may be lethal for long-term survival.  The benefits of long-term survival are non-existent if there is a failure of short-term survival.  This will be considered later in the consideration of obsessive/compulsive and addictive behaviors.

Principle Number 25.  The Character of Innate Forces.  The forces of Innate Intelligence never injure or destroy the structures in which they work.

            “The forces of Innate are constructive—not destructive.  While there is wear on the part that functions at the bidding of Innate, these parts are just as rapidly repaired….It builds all these, provides all their needs, circumvents adversity, repairs them when damaged, and maintains them until death.  Then, this power leaves them and they rapidly return to their elemental state—molecules and atoms.”  [Stephenson 1927, 263-265]

            The forces used by Innate Intelligence are always used for constructive, never destructive purposes in constructing, maintaining, and preserving the body as best as possible.  The destructive forces of universal law may cause wear and tear to parts of the body.  Innate Intelligence repairs these damaged parts as quickly as possible.  When Innate Intelligence no longer sustains these parts, they rapidly disintegrate into their basic parts.

Principle Number 27.  The Normality of Innate Intelligence.  Innate Intelligence is always normal and its function is always normal.

            “Intelligence is always perfect—always one hundred per cent.  The forces which it assembles are always correct.  They are not correct when they reach Tissue Cell if there is interference with transmission, but that is not because of imperfection in Innate’s work, but because of the limitations of matter.”  [Stephenson 1927, 269]

            Because the workings of Innate Intelligence are always perfect, the forces that is assembles are always perfect.  However, because of the limitations of matter, the materials used by Innate Intelligence are not always perfect for its needs.  It must then adapt to this limitation.  The limitations of matter can also interfere with Innate Intelligence’s transmission or reception of messages to or from the tissue cells.

Principle No. 28.  The Conductors of Innate Forces.  The forces of Innate Intelligence operate through or over the nervous system in animal bodies.

            “The brain is the headquarters of Innate’s control—the seat of the mind….Every tissue cell in the periphery has its nerve supply.  That means that every tissue cell has nerves which carry to it mental impulses.”  [Stephenson 1927, 270-272]

            The center from which Innate Intelligence works is the brain.  The nervous system is used to carry its messages.  Its knowledge and awareness of the internal and external environments is collected through the nervous system.  Until recently, it was thought that the spinal cord was merely a transmitter of messages between the brain and the end organs.  Recent research proves that the dorsal roots of the spinal nerves and the dorsal horn of the spinal cord are part of the limbic system and function as an extension of the brain, particularly in the realm of emotions.  [Pert and Dienstrey 1988;  Lewis et al. 1981]

Principle No. 29.  Interference with Transmission of Innate Forces.  There can be interference with the transmission of Innate forces.

            There will be adverse effects whenever there is any interference with the communication between Innate Intelligence and the tissue cells.  There will be a lack of coordination between the cells of the body.  The cell will continue to function for its own survival, but this is not necessarily advantageous for the body as a whole. 

            Stephenson expounds three theories to explain the interference with the communication of Innate’s forces.  1)  “If a nerve is made abnormal in any part (as by impingement) there cannot be normal function of that nerve cell, which is a living organism.  The mental impulse is robbed of some of its values and hence forth is (partially or wholly) not a perfectly assembled unit of energies as Innate sent it, but a somewhat dis-sembled unit.”  [Stephenson 1927, 295]  2)  “Interference with transmission of the message, that is interference with the vehicle of the message.  If the conductor of the current which is conveying the message goes wrong, the message becomes garbled, so that Tissue Cell does not understand it fully….The message is full of ‘static’ and unintelligible.”  [Stephenson 1927, 299]  3)  “A nerve cell which is impinged is not a cell ‘at ease.’  Therefore, it will not ‘vibrate’ normally in function….Therefore the tissue receives a message which does not ‘read true.’”  [Stephenson 1927, 299-300]

            It is now over 75 years since Stephenson wrote the above.  Many questions remain as to just what this interference is and what causes it.  Adverse effects throughout the body are the consequence of this interference.  Chiropractic has had phenomenal success reducing this interference, empowering the body in healing itself.

Principle Number 30.  The Causes of Dis-ease.  Interference with the transmission of Innate forces causes incoordination or dis-ease.

            “Interference with transmission prevents Innate from adaptating (sic) things universal for use in the body and from coordinating the actions of the tissue cells for the mutual benefit of all cells.”  [Stephenson 1927, 301]

            When Innate Intelligence receives a distorted picture of reality because of interference with transmission in the nervous system, it is then neither able to recognize its circumstances, both internal and external, nor respond appropriately.  It then fails to properly adapt universal forces to coordinate the tissue cell’s activities to harmonize with each other for their mutual benefit and the body’s overall health.  This is referred to as GIGO in computer technology:  garbage in equals garbage out.  The consequence of distorted input is distorted output.

Principle Number 31.  Subluxations.  Interference with transmission in the body is always directly or indirectly due to subluxations in the spinal column.

            B. J. Palmer defined the vertebral subluxation in Stephenson’s Chiropractic Textbook:  “Chiropractic definition:  a subluxation is the condition of a vertebra that has lost its proper juxtaposition with the one above, or the one below, or both; to an extent less than a luxation; and which impinges nerves and interferes with the transmission of mental impulses.  All the factors of the foregoing definition must be included in order that it be a Chiropractic definition….any abnormal position of a vertebra, such as posteriority, rotations, curvatures, and tilts, are subluxations if they impinge nerves and interfere with the transmission of mental impulses.”  [Stephenson 1927, 320]

            The vertebral subluxation was defined in the July 1996 policy statement of the Association of Chiropractic Colleges as follows:  A subluxation is a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health.  [Association of Chiropractic Colleges 1996]

            Since Chiropractic’s beginning in 1895, hundreds of different Chiropractic techniques and forms of analysis have evolved to care for the vertebral subluxation and its effects on health.  Most techniques fall into one of two categories:  those who view the subluxation as a structural problem, and those who view it as an interference in the meningeal system. 

            Structural subluxation theory views the subluxation as an improper alignment in the spine, either in a single joint or globally, resulting in either an impingement of the nerve root, or a tractioning of the spinal cord and/or nerve roots.  Meningeal system subluxation theory views the subluxation as a tension on, or a torquing of, the meninges resulting in a tractioning of the spinal cord and/or nerve roots, and a blocking of the flow of cerebrospinal fluid which causes improper metabolism in the nerves.  The truth probably encompasses both views. 

            In summation, Chiropractic holds that there is a Universal Intelligence that created and maintains everything in the Universe.  A specific portion of this Universal Intelligence is localized in a portion of matter (the body) to keep it actively organized.  This is called Innate Intelligence, whose function is to constructively adapt some of the forces and matter of the universe as needed, for the construction and maintenance of the body.  Innate Intelligence works through the brain, sending and receiving messages through the spinal cord, nerve trunks, and their branches, extending to and from the various tissues of the body.  The nerve trunks pass through the intervertebral foramina, where they are vulnerable to pressures or tension from spinal misalignments changing the size and shape of the intervertebral foramina.  Vertebral subluxations result because this interferes with the transmission of Innate Intelligence’s workings, either directly or indirectly.  The actions of Innate Intelligence are always perfect within the limitations of matter, specifically the interference with the transmission of these nerve impulses.  Innate Intelligence works to adapt the universal forces and matter for the body’s benefit.  Perfect adaptation results in health; imperfect adaptation results in dis-ease.  All dis-ease can thus be traced back to interference with the proper transmission of the nerve impulses.  The Chiropractor uses his science, art, and philosophy to locate, adjust, and correct this interference so that the Innate Intelligence can restore health to the body.  [Stephenson 1927, 1-2]

            The vertebral subluxation also interferes with the function of the dopamine receptors in the nervous system, particularly in the dorsal roots of the spinal nerves and the dorsal horn of the spinal cord.  This will lead to further altered function and incoordination.  This is often seen when obsessive/compulsive or addictive behaviors are used by Educated Brain in response to Innate Intelligence’s messages to increase the release of dopamine in the limbic system (including the dorsal roots of the spinal nerves and the dorsal horn of the spinal cord) until the vertebral subluxation can be reduced or corrected.

THE BRAIN REWARD CASCADE

            The Deoxyribonucleic Acid (DNA) molecule is made up of pairs of four bases.  Guanine always pairs with Cytosine while Thymine always pairs with Adenine.  These construct the approximately 3 billion base pairs that make up each DNA molecule in the chromosome.  Each parent contributes half of each base pair in the gene.  According to the best current estimates from the human genome project, there are approximately 30,000 genes on the 23 pairs of chromosomes in the human cell.  The production of all of the proteins and enzymes necessary for life is controlled by the genes as mediated by the nervous system.  If there is a defective gene, either the structure or the function of the body will be disrupted.

            The proper functioning of the dopaminergic and opioidergic reward pathways of the nervous system are critical in providing the pleasure drives for eating, love, and reproduction that are elemental in the survival of vertebrates.  The “natural reward” of pleasurable sensations involves the release of dopamine, the primary neurotransmitter in the brain reward pathway, in the nucleus accumbens, the frontal lobes of the brain, and the dorsal roots of the spinal nerves and the dorsal horn of the spinal cord.  These pleasurable sensations can also be mimicked with “unnatural rewards” such as alcohol, nicotine, amphetamines, marijuana, cocaine, and heroin; and by such stimulating behaviors as gambling, carbohydrate bingeing, compulsive sex, and high-risk activities that produce this same release of dopamine.  The proper functioning of the brain reward pathway and its proper sensations of pleasure are dependent on the genes that regulate the dopamine receptors and the synthesis, degradation, and transportation of dopamine.  [Blum et al. 2000, 21]

            While studying the alerting process in rats’ brains, Olds discovered the vital importance of the brain reward pathway in producing pleasure.  Electrodes were placed in part of the limbic system, which the rats were allowed to excite by pressing on a lever.  The rats would stimulate this area as often as 5000 times per hour, ignoring everything except sleep, even enduring severe pain to receive this stimulation.  In humans, electrical stimulation of the medial hypothalamus would generate a feeling of quasi-orgasmic sexual arousal.  [Olds and Olds 1969]  Further research demonstrated that stimulation to other areas in the limbic system would produce a light-headedness that eradicated negative thoughts.  From this it was concluded that pleasure must be a distinct neurological function linked to a complex reward and reinforcement system.  [Hall et al. 1977]

            Nicotine, opiates, cocaine, and ethanol enhance the release or block the re-uptake of dopamine, in one or more of the primary terminal sites of the nucleus accumbens.  The glucocorticoid receptors in the hypothalamus have been found to connect with the serotonergic system by opioid peptides which also cause the release of dopamine in the nucleus accumbens.  [Koob and Bloom 1988; Gessa et al. 1985]   Alcohol activates the norepinephrine receptors of the mesolimbic system by interacting with serotonin, opioid peptides, and dopamine.  It also forms neuroamine condensation products (TIQ’s) that interact with opioid receptors or directly with the dopaminergic systems.  [Airaksinen et al. 1984]

            To explain the neuropharmacology involved in substance use disorders, Blum and associates have developed the neurotransmitter model which they named the Brain Reward Cascade.  [Blum and Kozlowski 1990; Blum, Briggs and Trachtenberg 1989]  Their research demonstrates that the neurotransmitters in normal people work together in patterns of stimulation or inhibition.  These patterns of stimulation and inhibition spread downward from complex stimuli to complex patterns of response resembling a cascade, with the ultimate reward of feelings of pleasure and well-being.  [Stein and Belluzzi 1986; Cloninger 1983]  Even though this neurotransmitter system is not totally understood because of its complexity, we do know that the primary reward centers are in the mesolimbic system and frontal lobes of the brain, the dorsal roots of the spinal nerves and the dorsal horn of the spinal cord.

FIGURE 1

            The neurochemicals in the limbic system mediate all of one’s feelings and emotions.  These neurochemicals include numerous neuropeptides, the very basis of the emotions.  They are responsible for a person’s sense of well-being.  The neuropeptides suffuse the body.  From a biochemical viewpoint, if someone feels overcome by a particular feeling, they are overcome by the neuropeptide that mediates that feeling.  Even though science has traditionally separated the brain from the body, when we consider the neuropeptides, there is virtually no distinction between the two.

            The neuropeptides form a virtual network, integrating the whole organism by carrying information throughout the brain and body.  All parts are equal in this system as a network has no hierarchy.  Pert and Dienstrey’s research has shown that the limbic system, which is the neurosubstrate of the emotions, is made up of not only the amygdala and hypothalamus, but also the dorsal roots of the spinal nerves and the dorsal horn of the spinal cord.  Using radioactive tracing, they found that the dorsal roots and the dorsal horn are almost as richly endowed with neuropeptide receptors as the amygdala and hypothalamus are.  [Pert and Dienstrey 1988]  A direct connection exists between the nocioceptive reflexes at every level of the spine and the limbic system.  Every spinal level has an intimate relationship with the proper functioning of the limbic system.  [Blum and Holder 1997]

            Figure 2 demonstrates how the following interactions take place in the reward centers as researched by Blum and by Stein and Belluzzi [Blum 1989; Stein and Belluzzi 1986]:

·        Serotonin (1) in the hypothalamus (I) indirectly activates opiate receptors (2) and causes a release of enkephalins in the ventral tegmental region A10 (II).  The enkephalins inhibit the firing of GABA (3) which originates in the substantia nigra A9 region (III).

·        GABA’s normal role, acting through GABAB receptors (4), is to inhibit and control the amount of dopamine (5) released at the ventral tegmental regions (II) for action at the nucleus accumbens (IV).  When the dopamine is released in the nucleus accumbens, it activates dopamine D2 receptors (6), a key reward site.  Activation of the dopamine D1 receptor results in stimulation, but leaves the brain in a jittery state.  However, activation of the dopamine D2 receptor results in a calming, pleasurable effect.  This release is also regulated by enkephalins (7) acting through GABA (8).  The supply of enkephalins is controlled by the amount of the neuropeptidases (9) which destroy them.

·        Dopamine may also be released into the amygdala (V).  From the amygdala, dopamine (10) reaches the hippocampus (VI) and in the CA1 cluster cells (VII), stimulates dopamine D2 receptors (11), another reward site.

·        An alternate pathway involves norepinephrine (12) in the locus ceruleus A6 (VIII), whose fibers project into the hippocampus at a reward area centering around cluster cells which have not all been precisely identified, but which have been designated as CAx (IX).  When GABAA receptors (13) in the hippocampus are stimulated, they cause the release of norepinephrine (14) at the CAx site.

FIGURE 2

            The interactions of activities in the separate subsystems above merge together into the much larger global system.  These activities take place simultaneously and in a specific sequence, merging like a cascade.  The end result is a sense of peace, pleasure, and well-being when these systems work normally.  If there is a deficiency or imbalance, the system will work abnormally, causing the sense of well-being to be displaced by feelings of anxiety, anger, low self-esteem, or other “bad feelings”.  This can lead to the craving for a substance that masks or relieves those bad feelings such as carbohydrate bingeing, alcohol, or cocaine; or to other addictive behaviors such as compulsive gambling, compulsive sex, workaholism, or engaging in high risk activities.

            According to the Cascade Reward Theory, genetic defects or variations, prolonged stress, or long-term alcohol or drug abuse can lead to a self-sustaining pattern of abnormal craving behavior.  [Blum et al. 2000, 10-11]

REWARD DEFICIENCY SYNDROME

            Genetic variations can lead to the disruption of normal physiology, to the detriment of the body such as the mental retardation and other health problems seen in Down’s Syndrome.  Sometimes, these variations are not necessarily a disadvantage.  A so-called genetic “disease” may in reality be an evolutionary survival adaptation for a particular time, place or set of circumstances.  In sickle-cell anemia, the red blood cells are misshaped and are impeded from moving freely through the capillaries after they release oxygen to the cells.  This can lead to frequent and severe infections, an enlarged heart and abdomen, brain damage and impairment of the major organs.  However, in areas where malaria is rampant, there is a survival advantage, since carriers of the sickle-cell gene are less susceptible to the Plasmodium parasite that causes malaria.  Tay-Sachs disease seen in descendants of Eastern European Jews, makes the carrier less susceptible to tuberculosis.  While inheriting the gene from both parents is fatal within a few years, the inheritance of only one cystic fibrosis gene appears to protect its young bearers from diarrheal diseases such as cholera.  [Hartmann 1993, 13]

            The DRD2 gene is responsible for the body’s production of dopamine receptors.  The A1 allele variation causes a reduction in expression of the DRD2 gene compared to the more common A2 allele.  Those people with the A1 allele have approximately 30 percent fewer D2 dopamine receptors than those with the more common A2 allele.  [Noble et al. 1991]  The lower number of dopamine D2 receptors causes a hypodopaminergic function.  [Gardner et al. 1997a; Gardner et al. 1997b; Gardner et al. 1998]  Recent research has shown that those with ADHD have more dopamine reuptake transporters than the normal population.  The dopamine molecules are reabsorbed by the presynaptic terminal before they have enough time to reach the postsynaptic terminal.  The decreased amount of dopamine does not allow the neuron to send its reinforcing signals.  [Dougherty et al. 1999]

            These factors in turn cause these people to receive less of an emotional reward from activities that the majority of people find satisfying.  When measuring the quantity of dopamine D2 receptors with positron emission tomography, it was observed that people with normal D2 receptor levels had feelings of anxiety, restlessness, and dissatisfaction when using psychostimulants.  Those with low D2 receptor levels using psychostimulants, described feelings varying from pleasure to euphoria.  [Volkow et al.1999a; Volkow et al. 1999b]  A high correlation has been found between pathological schizoid/avoidant cluster and the presence of the A1 allele of the DRD2 gene.  In the early stages, these individuals are languid, remote, lacking passion, depersonalized, conflicted, hypersensitive, phobic, and self-deserting.  With the passage of time, they attempt to alleviate their symptoms of dysphoria by carrying out outrageous acts of violence, followed by comorbid substance use disorders.  [Blum et al. 1997a; Blum et al. 1997b]

            Those with the A1 allele often have difficulty coping with the stresses of life since dopamine helps reduce stress.  In an attempt at self-healing, they often search for temporary relief by seeking out those substances or behaviors that will stimulate the release of additional dopamine in the reward areas of the brain.  Many turn to alcoholism, substance dependence/abuse [Uhl et al. 1992], carbohydrate bingeing, nicotine abuse [Spitz et al. 1998; Comings et al. 1996a], pathological gambling, compulsive sex, compulsive work, conduct disorder, and other behavioral abnormalities.  [Blum et al. 1996a; Blum et al. 1996b; Nakajima 1989]  Research has shown that many of these disorders have the A1 allele of the DRD2 gene in common.  [Blum et al. 1990; Blum et al. 1995a; Blum et al. 1995b; Blum et al. 1996a; Blum et al. 1996b; Blum et al. 1996c]

            To a certain extent, the substances and behaviors noted above are interchangeable in their results.  Often, a person with the A1 allele variation will jump from one substance or behavior to another, or even use them in combination with each other, in their attempt to “feel normal”.

            The dopamine D2 gene could be called the “reward gene” because of its effect in controlling or modifying aberrant craving behavior and giving a sense of well-being when functioning normally.  Blum has given the name Reward Deficiency Syndrome to the group of disorders resulting from the abnormal functioning of the dopamine D2 gene.  To summarize Blum et al. in the November 2000 issue of the Journal of Psychoactive Drugs:  “We have not been able to determine if there are any advantages to this genetic vulnerability to addiction and/or obsessive/compulsive behavior.  But we do know that some people’s physiology is different, this physiology is genetically inherited, and some of these physiological changes can be induced by heavy exposure to alcohol and some other drugs by setting in motion perturbators of the neuro-chemistry and receptors.” [Blum et al. 2000, 2]

            Figure 3 displays a whole spectrum of these interrelated disorders, from the level of the genes, to the areas affected by these genes, to the resulting disorders.

FIGURE 3

            Disruption of the Brain Reward Cascade noted above (refer back to figure 2) results in the Reward Deficiency Syndrome.  The mild variety may be seen in the chain smoker while the severe variety is seen in the chemical addict.  These vast extremes in behavior are linked by their genetically-based biochemical inability to be rewarded by their daily activities. 

            The addictions to alcohol, nicotine, or cocaine; the obesity due to carbohydrate bingeing; ADD and ADHD, Tourette’s syndrome, and Post-Traumatic Stress Disorder are all centrally mediated Reward Deficiency Syndrome disorders.  There is a heightened predisposition for these disorders because of the decreased quantity of dopamine receptors and increased reuptake transporters, and consequently an inability to cope with stress.  This results in the craving for those substances or activities that cause the increased release of dopamine in the reward centers to temporarily relieve the stress and craving.  The consumption of carbohydrates, alcohol, nicotine, marijuana, cocaine, or the stimulation of gambling, compulsive sex, compulsive work and high-risk activities can be used individually or in combination, and to a certain extent, interchangeably.  Even though each substance and activity affects a different step in the Brain Reward Cascade, the results are the same:  dopamine is released at the reward sites in the nucleus accumbens, the hippocampus, [Koob and Bloom 1988; Cloninger 1987] the dorsal roots of the spinal nerves and the dorsal horn of the spinal cord.  [Pert and Dienstrey 1988; Blum and Holder 1997.]

            When there is a predetermined tendency toward these disorders due to a lack of adjustment to the underlying genetic variation, then one really cannot blame the carbohydrates, alcohol, nicotine, drugs, the orgasmic experience of sex, or the euphoria of gambling for their problems.  This genetic variation would appear to be an evolutionary blunder where one would be cursed with these problems since one’s conception.  But, could this possibly be nature’s protection against some hidden or unknown danger that we are not yet aware of?  Could this be an evolutionary development for the progression of mankind?  After all, many of those with the A1 allele variation score higher on IQ tests.  Processing information and stimuli more quickly, their brains have tendencies toward hyperactivity as seen in ADD and ADHD.  This genetic variation with its underlying susceptibility to feeling unfulfilled by the normal activities in life, may also allow increased intelligence, quicker processing of information, and an increased drive for accomplishment.  Because they have a greater tendency to turn to one of the obsessive/compulsive or addictive behaviors in an attempt to find a feeling of fulfillment, they need to find other approaches for coping and finding satisfaction in their personal relationships and daily activities.

            That is why it is crucial that the spine be subluxation-free.  Only then can the limbic system, particularly that part in the dorsal horn of the spinal cord and the dorsal nerve roots, be able to function normally.  Without the interference from spinal subluxations, the individual will finally be able to attain a feeling of satisfaction and well-being, and achieve his or her greatest potential.

IMPLICATIONS OF REWARD DEFICIENCY SYNDROME

            Many different processes can interfere with the Brain Reward Cascade and cause Reward Deficiency Syndrome.  These include not only the genetic variation of the A1 allele of the DRD2 dopamine receptor, but also decreased neurologic function due to physical, chemical, or emotional traumas, illness, nutritional deficiencies, and drug or medication interactions.  Those suffering from Reward Deficiency Syndrome attempt to compensate or “self-medicate” through using addictive chemicals or behaviors in order to feel good about themselves.  Their survival instincts direct them to seek whatever will give them feelings of self-peace, self-satisfaction, self-fulfillment, and well-being, even though only temporarily.  They crave the release of dopamine in the Brain Reward Cascade to achieve a false sense of well-being through their addictive or obsessive/compulsive behaviors.  Eventually, addictive or compulsive behaviors result in the over-utilization of chemical substances and/or mind-altering events.  Long term, these behaviors result in a further downward spiral and dependency because they create a further breakdown in this cascade of neurotransmitters.

            Researchers of addiction recognize five categories of addictions:  1) compulsive use of drugs/chemicals (including alcohol), 2) compulsive eating (particularly carbohydrate bingeing), 3) compulsive gambling, 4) compulsive sex (ranging from promiscuity to nymphomania or satyriasis), and 5) compulsive work (the only socially accepted, and even admired, addiction in Western society).  The research of Kenneth Blum, Ph.D., at the University of Texas Health Science Center in San Antonio, Texas ties together these 5 categories of symptoms as just one disease—addiction.  All involve the same breakdown of the Brain Reward Cascade pathways in the limbic system of the brain, dorsal horn of the spinal cord, and dorsal nerve roots of the spinal nerves.

            The first recognized cause of these addictive and compulsive behaviors is the genetic variation or flaw seen with the A1 allele of the DRD2 dopamine receptor.  Blum that found 69% of severe alcoholics had this genetic variation present, while only 20% of the non-alcoholic population had it.  This research led to the Brain Reward Cascade theory, where the proper release and utilization of dopamine in the nucleus accumbens area of the brain leads to a linear sequence of neurochemical events resulting in the ultimate feeling of well-being, satisfaction and peace.  Any interference in this cascade of neurotransmitters does not allow the potentially addicted person to be able to achieve the normal feeling of well-being.  Complicating matters is the fact that they are already deficient in dopamine utilization because of the genetic deficiency in the number of dopamine D2 receptors and increased reuptake transporters.

            Jay Holder, D.C., M.D., Ph.D., states that his research has shown that of those babies delivered with forceps or suction cups, approximately 90% have a subluxated cervical spine.  The spinal cord is dangerously stretched and the vertebrae become misaligned because of the tremendous forces used during delivery.  In turn, these children have a greatly increased risk of becoming addicted as adults because of their nervous system dysfunction, particularly in the limbic system found in the dorsal horn of the spinal cord and the dorsal roots of the spinal nerves.  This risk is even more frequent if the child already has the genetic variation involving the A1 allele of the DRD2 dopamine receptor.

            This same genetic DRD2 dopamine receptor variation has been found by Blum and Holder in those children afflicted with Attention Deficit Hyperactivity Disorder and Tourette’s Syndrome.  It is estimated that these compulsive disorders affect approximately 10 percent to as high as 20 percent of the children in the United States.  [Richard Leviton 1995, 17-18]

EDUCATED BRAIN AND EDUCATED MIND

            From the perspective of Chiropractic Philosophy, the question arises:  How are Innate Intelligence, Educated Brain, and Educated Mind involved in obsessive/compulsive and addictive behaviors?  Let’s take a look again at the Chiropractic Textbook written in 1927 by R. W. Stephenson.

            EDUCATED BRAIN.  That part of the brain used by Innate as an organ for reason, memory, education, and the so-called voluntary functions.  The seat of Educated Mind.  It is supplied with mental impulses over nerves, as any other tissue.  It is liable to incoordination as any other tissue; . . . It is the chief organ of adaptation to environmental conditions.

            Innate Intelligence uses the Educated Brain as the organ to direct voluntary functions.  Information about the external environment is dispatched by the Five Senses to the Educated Brain.  The Educated Brain constantly compares this information with past impressions so that the body can profit by avoiding actual or threatened dangers.  Educated Brain also stores information about what has worked or not worked for the benefit of the body for future use by Innate Intelligence.  [Stephenson 1927, 13-14]

            EDUCATED MIND.  Educated Mind is the activity of Innate Intelligence in the Educated Brain as an organ.  The product of this activity is Educated Thoughts; such as, reasoning, will, memory, etc.  Innate controls the functions of the “voluntary” organs via the Educated Brain.  Educated thoughts are mostly for adaptation to things external to the body.

            Educated thoughts such as learning, will, memory, and reasoning are used to adapt to the external environment.  They are used for the welfare, comfort, betterment, and safety of the body.  Successful adaptations always give pleasure.  Unsuccessful adaptations will cause harm to the body, and can even be fatal.  [Stephenson 1927, 242-243]

            If Innate Intelligence is infinite in her wisdom, how can she allow the body to become addicted?  Stephenson says the following:      

Innate Intelligence, the builder and warden of the body, with her infinite knowledge knows her own mind; knows what should be introduced into the body, both immaterial and material.

            Educated Brain is finite and must work within the limitations of matter, therefore it cannot decide for Innate Intelligence what forces or matter are good for the body.  Innate Intelligence will proclaim her material needs through normal hunger and thirst.  The purpose of Educated Brain is to deliver whatever Innate Intelligence determines is needed.  The Educated Mind should cooperate, not hinder, Innate Intelligence’s workings through Innate Mind in its choice of nourishment for the body.  When Educated Mind interferes with Innate Mind, it is because it is abnormal.  Interference with transmission because of vertebral subluxation(s) causes this abnormality.  Instead of working with Innate Intelligence in harmony, Educated Brain begins to work against the best interests of the body.  [Stephenson 1927, 129-130]

            When a poison such as an addictive drug is first ingested in the body, Innate Intelligence responds with great energy to eliminate and excrete the poison with any method at its disposal.  When there is a strong dose of poison, Innate Intelligence responds immediately with the quickest method at its disposal, a mechanical reaction, which may result in a vertebral subluxation.  Innate Intelligence next initiates the proper preparation of an antidote for the poison.  When the poison is repeatedly ingested, Innate Intelligence continues to rebel, but also adapts by continuing to manufacture the antidote to keep the body chemically balanced, until it is manufactured continuously.  Then if the ingestion of the poison is stopped, the body becomes unbalanced again.  The antidote causes stress, since it is now a poison in the body.  Innate Intelligence now craves the original poison to offset the poison of the antidote.  The body will go into the withdrawal process if the poison is not provided.  Eventually, Innate Intelligence will destroy the antidote and stop manufacturing it.  In the words of R. W. Stephenson, “Subluxations play their part in all this, in the matter of incoordinated educated mind, poor elimination, and inadequate adaptation in the matter of balancing drug and antidote for every day’s struggle.”  [Stephenson 1927, 153-154]

            When Educate Brain receives inaccurate information because of the presence of a vertebral subluxation, it may respond with a faulty adaptation.  The person with a decreased number of dopamine receptors in the nucleus accumbens, the dorsal horn of the spinal cord, and the dorsal nerve roots of the spinal nerves that make up the limbic system, will have an impediment to achieving a sense of well-being.  Innate Intelligence orders Educated Brain to compensate for the lack of dopamine.  Educated Brain may respond imperfectly in its choices due to vertebral subluxations and the limitations of matter.  It may turn to mind-altering addictive chemicals, obsessive/compulsive behaviors, or mind-altering events to temporarily increase the dopamine levels, rather than having the vertebral subluxations adjusted and searching for the balanced nutrition that is needed.  This may offer temporary relief from the immediate symptoms of discomfort, anxiety, and distress.  This is very destructive to the body in the long term.

            It is vital in the care of obsessive/compulsive and addictive behaviors to include vertebral subluxation reduction and correction.  Only then can the dysfunction be identified, the messages from Innate Intelligence be properly responded to, and the body begin to heal and function naturally.

CHOICE OF ADDICTION

            One may wonder if obsessive/compulsive or addictive behaviors are the fault of a person’s heredity and genetic variations, or if the environment and influences of society are more to blame.  There is a greater tendency to develop these behaviors when one inherits the A1 allele variation of the dopamine DRD2 receptor gene.  But not everyone develops the same disorders, a few people even find ways to cope and live fairly normal lives.  Casey did extensive research to answer the question of heredity or environment, but came to no absolute conclusion.  [Casey 1960]  It appears that people do have some freedom in their choice of obsessive/compulsive and/or addictive behaviors from what are available to them environmentally, financially, and within their moral values.

            Alcoholism, carbohydrate bingeing, drug abuse, and compulsive gambling do not always have a genetic basis.  Research has demonstrated that a considerable number of severely addicted people begin their substance dependence and abuse because of the DRD2 genetic variation affecting the limbic system’s reward center.  [Chipkin 1994]  The picture is further complicated by such environmental factors as social structure, economic status, family, occupation, and substance availability.

            The somatopsychological responses may be the mind’s way of coping with or adapting to this genetic variation.  The real origin of all behavior, whether the socially accepted “normal” or the socially unacceptable or “abnormal”, is determined at conception by one’s genes.  While the multiple combinations and variations of these genes will predispose these people to these behaviors, these will also be shaped by the environmental influences of their family, friends, their level of education, their economic and social status, various environmental pollutants, and the availability of psychoactive drugs.  [Blum et al. 2000, 64]  Due to the decreased levels of dopamine released in the nucleus accumbens, they cannot achieve a sense of well-being.  Therefore they search for outside stimulation; whether chemical or behavioral, to temporarily attain this feeling artificially.  [Blum et al. 2000, 3]

            Even after prolonged abstinence, the craving persists once they become addicted to psychoactive drugs.  They may then use other behaviors, ranging from the socially positive (compulsive workaholism) to the socially negative (compulsive sex or gambling) to satisfy their craving.  Their choice of stimulant, either chemical or behavioral, then depends on the availability and accessibility along with the perceived costs and risks.  [Blum et al. 2000, 2]

            The American Indians are a prime example of the availability and/or accessibility in their choice of stimulant.  The Indian cultures used various stimulants and hallucinogens such as tobacco, hemp, peyote, and psychogenic mushrooms.  With the arrival of the Europeans, they began using alcohol, causing a total disruption of their society.  Among the more affluent, such as professional athletes and the Hollywood movie industry, cocaine is often the drug of choice.  (As Robin Williams said, “Cocaine may be God’s way of telling you that you have too much money.)  Alcohol, nicotine, and marijuana are often the choices of the lower end of the economic scale.  As an example of looking at the cost versus risk factor, a person may select a high nicotine brand of cigarettes rather than risking problems from the illegal use of marijuana.  Compulsive gambling behavior can even be replaced by less risky behaviors such as the compulsive playing of bingo, video and computer games, or virtual reality games. 

            Personal choice has a large influence on the choice of one addiction or behavior over another due to life experiences, personal values, and societal mores.  A young female may have inherited the same Reward Deficiency Syndrome as her alcoholic mother and drug abusing father.  She may have so much pent up rage toward her parents that she vows to never use alcohol or drugs.  She will search for another method to achieve a feeling of well-being.  Starving for male attention and affection, but having a poor relationship with her father, she turns to other males.  Sexual intercourse temporarily satisfies her need for male attention and affection, while also releasing enough dopamine for a temporary sense of well-being.  This behavior becomes addictive as she needs a continual “fix”, eventually leading to promiscuity or nymphomania.

            A young male on the other hand may grow up in a family in which it is considered a sign of manliness and virility to have sex with as many females as possible.  Often, heavy use of alcohol and mind-altering drugs goes along with this type of behavior.

            Carbohydrate bingeing may be the outlet for another family with a cultural or religious aversion to drugs, alcohol, and illicit sex.  Wheeling and dealing in the world of business may be a more acceptable outlet than casino gambling.  A person may become a world-class chef, getting his excitement from creating and cooking, and the enthusiastic praise of others, rather than from overeating.  The potential alcoholic may sublimate his craving by becoming a connoisseur of wine, deriving his sense of satisfaction and excitement from pursuing the new taste experience rather than the actual drinking. 

            Being passionate about a goal or pursuit can compensate and give one that sense of well-being as the Brain Reward Cascade of neurotransmitters ultimately releases more dopamine in the reward centers of the limbic system.  Each person chooses their own personal method of compensation.

ADD/ADHD OVERVIEW

            Between three and four million children, and probably even more adults, are afflicted with what is currently referred to as Attention Deficit Hyperactivity Disorder (ADHD) (with or without hyperactivity) or sometimes as Attention Deficit Disorder (ADD).  ADD/ADHD is the most frequently observed of the obsessive/compulsive disorders.  Some researchers use the term ADHD when the symptoms of hyperactivity are present, and ADD when no hyperactivity is present.  The ADD/ADHD child demonstrates a group of maladaptive or disorganized behaviors which put him or her out of sync with the surrounding adults.  It is a variation of normal behaviors that appear more frequently, more obviously, and more intensely than is seen in other children of the same age.  While all children are impulsive, distractible, and inattentive some of the time, ADD/ADHD children are impulsive, distractible, and inattentive most of the time.  [Sears and Thompson 1998, 6]  There is a continuum of behaviors that range from the young girl who is “spacey” and always daydreaming to the young boy referred to as “hell on wheels” and “the human tornado” as he runs continually at top speed, knocking everything and everyone over, rarely stopping to rest.

            For the purposes of this paper, we can think of ADD as the person who “fogs out” which results in a deficit to attention, while the person with ADHD “acts out” with hyperactivity resulting in a deficit to attention.  ADD is characterized by the anxious, preoccupied, and dreamy child who is often described as apathetic, lazy, unmotivated, and not very smart.  ADHD is characterized by the child with a hyperactive brain, which is also often expressed with hyperactive movements.  Their thoughts appear to be disjointed to an observer as their brain races from one thought to another.  They are easily distracted and/or have difficulty focusing on only one thing at a time.

            It was formerly thought that three to four times more boys than girls are afflicted.  It has since been realized that girls more often display the ADD form without hyperactivity.  Consequently the diagnosis is often missed as they are written off as being “spacey”, “ditzy”, or just always “daydreaming”.  Boys tend to more often display a physically active and aggressive form of ADHD, irritating their peers and the adults around them.  Adjusting for these differences, the incidence is approximately equal in both sexes.

            The names ADD and ADHD imply that the diagnostician actually understands the neuropsychological processes involved.  But the reality is that ADD/ADHD cannot be measured in precise scientific terms.  The diagnosis is made from the list of symptoms published in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).

            In 1902, pediatrician George Still was the first to describe a group of hyperactive, impulsive, and inattentive children, though he labeled them as being “morally defective”.  Before Dr. Still, ADD/ADHD was not recognized, even though the temperament or biological predisposition was present.  More alternatives existed for the child who could not sit quietly in school.  He or she could help out on the farm, work in the family’s store, or help care for their younger siblings.  With compulsory education in the twentieth century, children had to function in this environment.  In the bad old days, children who misbehaved in school were beaten into submission.  Today, that option is rightly rejected; however, while we are no longer willing to intimidate children into compliance, we seem to be willing to drug them into it.  [Diller 1998, 89-90]

CAUSES OF ADD/ADHD

            There appears to be a genetic basis as ADD/ADHD often runs in families.  Between 10 and 35 percent of ADD/ADHD children have an ADD/ADHD parent.  If one parent has ADD/ADHD, approximately 60 percent of their children will also have ADD/ADHD.  This rises to 85 to 90 percent if both parents have ADD/ADHD.  [Amen 2001, 22-31]  ADD/ADHD is seen more often in identical than in fraternal twins.

            Current research implicates the A1 allele variation of the dopamine D2 receptor as the most frequent cause of ADD/ADHD symptoms.  This gene also predisposes the bearer to other addictive behaviors, especially when a conduct disorder is present.  [Disney 1999; Comings 1991; Blum et al. 1990]  As previously seen with the Reward Deficiency Syndrome, these compulsive disorders are the end result of the neurotransmitter imbalance in the Brain Reward Cascade.

            Researchers have correlated ADD/ADHD symptoms with not only the DRD2 dopamine receptor gene on chromosome 11, but also aberrations of the DRD4 dopamine receptor gene on chromosome 11, the DAT1 dopamine transporter gene on chromosome 5, the HLA gene on chromosome 6, p21.3 on chromosome 6 affecting production of fatty acid-CoA transferase, q11.1-q13 on chromosome 16 and p11-p12 on chromosome 20 which both affect the production of phospholipase C.  [Amen 2001, 22-31; Stordy 2000, 16-17]  Fatty acid-CoA transferase is associated with the conversion of short chain essential fatty acids into long chain polyunsaturated acids and their incorporation into nerve cell membranes.  Phospholipase C is associated with the breakdown of phospholipid membranes in brain cells.  It is critical that both of these processes are in balance for the normal, rapid fire communication between neurons.  [Stordy 2000, 8, 16-17]

            To a lesser extent, ADD/ADHD symptoms are seen as the result of head injuries (especially the left temporal region), lack of oxygen (e.g. cord wrapped around the neck during delivery or drowning accidents), meningitis and encephalitis, toxic substances (fetal exposure to drugs, alcohol, cigarettes, lead), and thyroid conditions.  [Amen 2001, 22-31]  In each of these situations, there is an adverse affect on the dopamine rich areas in the limbic system.

SYMPTOMS AND CONSEQUENCES OF ADD/ADHD

            Many children are hyperactive even in the womb.  Many are challenging from birth:  sensitive to noise and touch, difficulty in being comforted, cautious and fearful, fussy eaters, colicky, and/or difficulties with sleeping.  As a toddler, the child is often excessively active, fidgeting, squirming, running around, high-strung, making excessive noise, impulsive, mischievous, demanding, noncompliant with parental requests, difficult to toilet train, disorganized, and more reckless and accident-prone than his or her peers.  Though not intentionally defiant, the child frequently breaks rules, interrupts others’ activities, and refuses to wait for his or her turn.  The child does not grasp the consequences of his or her actions, but rather blames everyone else for his difficulties.  Lacking normal caution and reserve, these children lack the tact expected for their age, impulsively finishing others’ sentences, giving answers before the question is finished, and blurting out whatever comes to mind.  Many isolate themselves because these actions make them unpopular with their peers.

            Entering school only makes the problems worse as they are easily distracted by everything going on around them.  They have difficulty with organization and paying attention to details.  Consequently, they make many careless mistakes, lose their schoolbooks and assignments, procrastinate, and fail to complete their schoolwork.  Often they talk excessively and at inappropriate times, are disruptive in class, and appear to not listen when spoken too.  Their behavior is often uninhibited and inappropriate.  They have difficulty playing quietly and waiting their turn becomes an even bigger struggle.  Often they are described as very intelligent but socially immature.  They have poor peer relations and are often labeled as underachievers, willful, defiant, or oppositional.

            The symptoms of impulsive behavior and motor hyperactivity usually decrease during adolescence.  However, the impulsive behavior, restlessness, boredom with anything that is not highly stimulating, and lack of tact persists.  [Amen 2001, 36; Web site of the U. S. Surgeon General, 2001]  Moods and behaviors can change suddenly, for no apparent reason.  A five-year-old may have the vocabulary of an eight-year-old while displaying the self-control of a three-year-old.  A seemingly independent child may become clingy and demanding later in the day, wanting a pacifier at night.  The ADD/ADHD child usually remains 30 percent behind his peers in maturity.  The ten-year-old child will act more like a typical seven-year-old, while the twenty-five-year-old adult may still have the maturity we would expect of an eighteen-year-old.  [Turecki 2000, 14-15; Bissen Neuville 1995, 32-33]

            The minds of those with ADHD are always racing.  The rest of the world just moves too slowly for them as others cannot keep up with their tempo. They view others as boring, preoccupied with irrelevant details, or even lacking in intelligence because others cannot keep up with the speed of their thoughts and actions.  In their view, they do not suffer from hyperactivity, rather the world suffers from AEHD—Attention Excess Hypoactivity Disorder.  Oftentimes focus becomes a problem because of the racing of their minds.  They compensate for a maddeningly slow world by multi-tasking:  reading a book while carrying on a conversation or doing the homework for one class while taking notes during the lecture in another class.  (You know you have ADHD when you read the paper, put on your makeup, and talk on the phone, all at the same time—while driving.)

            When the ADHD person is bored, motor activities spill over such as drumming the fingers, tapping the feet, whistling, looking around, scratching, stretching, and doodling.  By absorbing part of the brain with motor activities, the rest is able to focus on the task at hand.  When something interesting or exciting engages the brain, the non-productive motor activities decrease.  Those with ADD/ADHD often become incapacitated when they have to write because of difficulties with fine motor skills.  They go into overload when required to copy from the blackboard, fill in blanks that are too small in their workbooks, write complete sentences, or make legible handwritten notes.  [Garber 1996, 68]

            People with ADD/ADHD are unable to filter out the background noise in the neighboring environment because of the overload and discord in their nervous systems.  Concentration is obstructed by the increased awareness of every sight, sound, and sensation constantly bombarding them.  Not able to focus their attention, they are always in a hurry, have trouble setting goals, forget appointments, miss deadlines, forget to pay their bills, and have frequent legal problems because they fail to take care of problems when they occur.  While often very intelligent people, they have difficulty adjusting to change.  In a world that is too bright, too loud, too abrasive, and changing too rapidly, they are in constant overload.  Nonessential stimuli cannot be differentiated from essential stimuli, as it all merges into a disorganized, unbearable bedlam.  There is so much tumult in life that even the most minor change in routine is very distressing.  The stress of being in overload is so severe that frustration cannot be tolerated—leading to sudden, explosive anger, temper tantrums, and harsh language.  The extreme frustration leads to impatience.  Often there are also problems with orientation in time and space, causing difficulty with following instructions, reading maps, or telling time.  [Blum and Holder 1994; Blum et al., 2000, 28]

            The seriousness of this problem in society is seen in that those with ADD/ADHD:

• have more medical visits and emergency-room visits
• 25 percent repeat at least one grade
• 35 percent never finish high school
• 19 percent smoke cigarettes compared to 10 percent of the general population
• 52 percent with untreated ADHD turn to drugs or alcohol
• 43 percent of untreated hyperactive boys will be arrested for a felony by age 16
• 50 to 75 percent of inmates have ADHD
• 75 percent have interpersonal problems—more motor vehicle accidents, speeding tickets, citations for driving without a license, and suspended or revoked licenses
• the parents of ADHD children divorce 3 times more often than the general population.

            Those with ADD/ADHD are two to three times more likely to fail their classes than their peers.  They score lower on achievement tests for math and reading, are often one to two years behind their peers in math, reading, spelling, and language.  Weiss and Hechtman found that as adults, one third had failed to graduate from high school.  [Garber 1996, 104-105]  Complicating this is the fact that the harder many ADD/ADHD people try, the worse things get.  Brain imaging studies demonstrate that when they try to concentrate, the part of the brain affecting concentration, focus, and follow-through shuts down—just when they most need it to turn on.  [Amen 2001, xvi-xvii]

DIAGNOSING ADD/ADHD

            According to the Diagnostic and Statistical Manual for Children and Adolescents for Primary Care, 4th edition (DSM-IV), ADHD can be diagnosed from the following:

Diagnostic Criteria for Attention Deficit Hyperactivity Disorder

TYPES:

1. Attention Deficit Hyperactivity Disorder Predominantly Inattentive

Must have at least six items from criteria one for six or more months.

2. Attention Deficit Hyperactivity Disorder Hyperactive-Impulsive

Must have at least six items from criteria two for at least six or more months.

3. Attention Deficit Hyperactivity Disorder Combined

Must have at least six items from criteria one plus six items from criteria two for at least six months.

CRITERIA ONE: INATTENTION

The following items must be to a degree that is maladaptive and inconsistent with an individual's developmental level.

A.     Often fails to give close attention to details, makes careless mistakes in school, work, or other activities.

B.     Often has trouble sustaining attention in tasks or at play.

C.    Often doesn't listen when spoken to directly.

D.    Often doesn't follow through on instructions.  Fails to finish work in school, chores, or duties in the workplace.  (Not due to oppositional behavior or failure to understand instructions.)

E.     Often has trouble organizing tasks and activities.

F.     Often avoids, dislikes, or is reluctant to engage in tasks that require sustained effort.

G.    Often loses things necessary for tasks and activities.

H.     Often distracted by extraneous material.

I.         Often forgetful in daily activities.

CRITERIA TWO: HYPERACTIVE-IMPULSIVE

The following must be to a degree that is maladaptive and inconsistent with an individual's developmental level.

Hyperactive:

A.     Often fidgets with hands and feet or squirms and seat.

B.     Often leaves seat when remaining seated is expected.

C.    Often runs and climbs in situations which are inappropriate.

D.    Often has trouble quietly playing or engaging at leisure.

E.     Often on the go or acts as if driven.

F.     Often talks excessively.

Impulsivity:

A.     Often blurts out answers before questions are completed.

B.     Often has difficulty waiting turns.

C.    Often interrupts or intrudes on others.

OTHER CRITERIA

1.      Some symptoms or impairments were present before the age of 7.

2.      Some impairment from the symptoms must be present in at least two or more settings (work, home, school, or play).

3.      There must be clear evidence of clinically significant impairment in social, academic, or occupational settings.

4.      The symptoms do not occur exclusively during the course of pervasive developmental disorders, schizophrenia, or other psychotic disorder, and are not better accounted for by other mental disorders such as mood disorders, anxiety disorders, dissociative disorders, or personality disorders.  [American Academy of Pediatrics 1997]

            Josephine Wright, M.D. has further adapted these standards for the common signs of ADD/ADHD as seen in the adult to include the following:

1. An inability to concentrate for any length of time.
2. An inability to finish assigned projects on deadline.
3. Poor organizational skills.
4. Procrastination, especially where work is concerned.
5. Difficulty in sustaining interest and focus over a length of time or through to completion of the project.
6. Few interests and hobbies; a tendency toward boredom.
7. Difficulty interacting with superiors and co-workers (and often family and friends).
8. Difficulty coping with the small "waits" in life, such as traffic lights, supermarket checkout lines, and business meetings.
9. Poor memory.  Many ADD/ADHD sufferers overcome this problem by writing down everything they need to remember throughout the day or placing reminders in visible locations.
10. Extreme distractibility and restlessness.
11. Impulsivity, such as blurting out an answer before being asked, interrupting another speaker, or saying something before considering the consequences.  This may also manifest in impulsive actions, like frequently changing jobs, impulsively shopping or spending money, impulsive eating, and rapidly changing one's mind.
12. An overwhelming need to be in motion.  Adults with ADHD usually don't run around the room like they did when they were children, but it's not uncommon for them to constantly jiggle a leg, tap their fingers, or suddenly stand up in a meeting and walk out of the room.
13. An addictive personality.
14. Poor self-esteem, based on years of perceived failure.
15. A hair-trigger temper.
16. A tendency toward physical aggression.  [Wright 1997, 63-64]

            Though not mentioned in the above criteria, there are several other symptoms that are often seen with ADD/ADHD.  Approximately 50 percent of ADD/ADHD children have difficulties with coordination such as trouble coloring, cutting with a pair of scissors, tying their shoelaces, and buttoning their clothes.  Handwriting is often extremely frustrating and nearly illegible as the words over-run the lines, the sides of the page, and each other.  Sometimes there are mild difficulties with balance as in learning to ride a bicycle, or poor hand-eye coordination with awkwardness throwing, catching, and hitting a ball.  [Wender 2000, 24]  Spatial and/or verbal dyslexia is observed in 71 percent of ADD/ADHD children under 13 years old.  [Gross 1997, 64]

            Overreactivity is often observed with excessive irritability or anger being displayed during frustrating activities.  ADD/ADHD children (and even adults) have a much lower tolerance for frustration and disappointment, reacting with temper tantrums, angry outbursts, crying or sullen spells with little provocation or justification.  Often described as angry, this is more a display of irritability and a hot temper rather than aggressiveness or hostility; a hyperreactivity to comparatively minor situations.  [Wender 2000, 27-28; Maxey, 1993, 9-12]

            Insatiability and boredom also seem to be common characteristics.  These children are never satisfied for very long, rarely getting the pleasure from activities that other children enjoy.  They often are disruptive or seek excitement and dangerous situations to experience the pleasure that other children derive from less stimulating activities.  There is a perpetual sense that there must be something more satisfying somewhere else.  Many mothers note that their offspring have not been able to be satisfied since early infancy.  Wanting everything right now, they have difficulty waiting for gratification.  Acting in egocentric ways, they ignore the balance between giving, taking, and sharing with their peers.  [Wender 2000, 60; Maxey 1993, 9-12; Gross 1997, 41]

            ADD/ADHD individuals are hypersensitive compared to other people.  They are more likely to have a history of frequent colds, upper respiratory infections, ear infections, asthma, eczema and allergies.  People view them as being “thin skinned” or “too sensitive”.  Telling them to stop being “so touchy”, makes as much sense as telling a hay fever sufferer to stop being “so allergic”.  [Mate’ 1999, 59.]  The frequency of otitis media in early childhood has also been connected with later hyperactivity.  [Hagerman and Falkenstein 1987]

            It has been found that 79 percent of ADD/ADHD children under age 13 have trouble falling asleep.  They may take from 30 minutes to 3 hours to fall asleep, especially on days when they have not had intense physical activity.  Rituals are often developed to deal with the frustration and irritation of lying awake, such as listening to music, reading, or counting things in their head.  [Gross 1997, 47-48]

            Approximately 90 percent of ADD/ADHD children under the age of 13 are very slow waking up in the morning.  They are hard to arouse, moody, grumpy, ill-humored, quarrelsome, and difficult to be with in the morning.  Their mind is cloudy and disorganized; they are slow in coming for and finishing breakfast, and late getting on the bus and arriving at school.  Sometimes this appears to be a psychological problem, because they can jump out of bed on mornings that promise excitement such as watching TV cartoons, playing with a new bicycle, going skiing, going to Disneyland, or any other appealing, high-adventure, high-interest activity.  Both ADD/ADHD children and adults respond with plenty of interest and energy to high-energy stimuli.  Unfortunately most mornings cannot promise such high adventure activities.  [Gross 1997, 50-51]

            Fifty percent of children with ADD/ADHD have a history of bedwetting.  Monroe Gross, M.D. asserts that bedwetting does not occur in children without ADD/ADHD neurology unless there is a physical abnormality or disease of the urinary tract.  [Gross 1997, 61]

            Many children and adults with ADD/ADHD have difficulty with peer relationships because of their inattentiveness to social feedback cues, facial expressions and verbal expressions.  Negative feedback goes unnoticed and social rewards are weak for these persons.  They often blurt out inappropriate, ill-timed statements or respond with improper actions.  This frequently leads to verbal abuse, rejection, ostracism, and social isolation by their peers.  Frequently, those with ADD/ADHD have no clue as to why they have social problems, what they have done wrong, and why nobody likes them.  [Maxey 1993, 9-12]

            Most people describe time as flowing in a consistent, linear fashion.  When ADD/ADHD individuals are on task, there is a pervading urgency about everything.  Life is viewed as an endless, relentless series of white-knuckle events.  The low frustration tolerance, recklessness, poor planning and judgment, disregard for injury, and antisocial behavior all boil down to an overpowering impulse to act.  They have a “let’s get it over with” attitude, rather than doing it right the first time.  This urgency cannot be ignored and is not susceptible to reason, inhibition, socialization, or suppression—it is compelling, distressing, and uncontrollable.  And when there is nothing to do, there is an overpowering sense of boredom.  This many times will lead to drug and alcohol abuse, which alter the perception of time.  Because the sense of time becomes elastic, many ADD/ADHD adults describe emotional highs as flashing by, while the emotional lows seem to last forever.  [Hartmann 1993, 3;  Wender, 2000, 215; Maxey, 1993, 9-12].

            Because of their brain chemistry, those with ADD/ADHD feel negative more frequently and more intensely than their peers.  Having low self-esteem and little self-confidence, they often make statements of guilt and self-reproach, some even having a tendency to self-mutilation and suicide.  Children are unlikely to talk about feeling “negative” or “depressed”, but rather use substitute words and phrases such as “bored”, “not interested”, “feel disliked by others” and “feel ugly”.  Depression is also quite commonly seen.  Children are then apt to state that “nobody at school likes me”, or complain that they “want to die”, “hate everybody”, or “wish that they were dead”.  [Wender 2000, 60; Gross 1997, 60]

            ADD/ADHD can also have its creative side:  the tendency to see life’s elements in new ways, combining bits of personal experience into new forms, giving shape to new ideas.  There is a greater tolerance of chaos because they are constantly distracted by stimuli that they cannot screen out.  Living in confusion, the pieces of life can be put together in novel ways.  What is creativity but impulsivity gone right?  Ideas come out of nowhere, which is where many ADD/ADHD people live.  Their minds are not here or there, but rather here and there, all over the place, precisely nowhere.  While their minds wander all over when not engaged, they fiercely attach onto a subject when engaged, almost to the point of an obsession.  The hyper-reactivity of their minds with the continuous churning of ideas increases the number of collisions in the brain, with the potential to release new ideas.  The challenge is to harness these processes productively.  Too often, their creative energies are like a live wire without a socket to plug in to as their energies dissipate unchanneled.  [Hallowell and Ratey 1994, 176-178]

THE 6 TYPES OF ADD/ADHD

            Using SPECT imaging, Daniel Amen, M.D. has found that ADD/ADHD affects several areas of the brain.  Most frequently affected is the prefrontal cortex which controls concentration, attention span, organization, planning, judgment, and impulsive behavior.  Other affected areas are the anterior cingulate gyrus which transfers information between the sides of the brain, the temporal lobes which store memories and experiences, the basal ganglia which produce the neurotransmitter dopamine that drives the prefrontal cortex, and the deep limbic system which is the seat of emotions.  [Amen 2001, xviii-xix]

            From his research, Dr. Amen has characterized six types of ADD:

• Type 1—Classic ADD:  inattentive, distractible, disorganized, hyperactive, restless, and impulsive.
• Type 2—Inattentive ADD:  inattentive, sluggish, slow-moving, low motivation, often described as space cadets, daydreamers, or couch potatoes.
• Type 3—Overfocused ADD:  trouble shifting attention, frequently stuck in loops of negative thoughts or behaviors, obsessive, worry excessively, inflexible, frequently behave oppositionally and argumentatively.
• Type 4—Temporal Lobe ADD:  inattentive, irritable, aggressive, have dark thoughts, mood instability, severely impulsive.
• Type 5—Limbic ADD:  inattentive, experience chronic low-grade depression, negative (e.g. “glass half empty syndrome”), low energy, frequent feelings of hopelessness and worthlessness.
• Type 6—“Ring of Fire” ADD:  inattentive, extremely distractible, angry, irritable, overly sensitive to environment, hyperverbal, extremely oppositional, experience cyclic moodiness.

            Knowing the type of ADD is critical to successful treatment.  Proper care results in a quick and dramatic improvement, while using standard remedies makes some types of ADD/ADHD worse.  [Amen 2001, xix-xx]

            Type 1—Classic ADD is the most commonly seen type and is caused by a relative deficiency of dopamine.  The sufferer struggles with ADD when their dopamine becomes low.  Stimulants such as Ritalin enhance dopamine availability in the caudate nucleus of the basal ganglia.  This area is very important in psychiatry as it is involved in motivation and anxiety control.  The caudate nucleus has many nerves connecting it with the prefrontal cortex, but it cannot drive the prefrontal cortex when the dopamine levels are too low.  If dopamine levels become too high (e.g. an overdose of stimulants), the person becomes overfocused or stuck in negative thought patterns and behaviors.  [Amen 2001; 84, 86-87]  The prefrontal cortex, considered the most evolved part of the brain, is made up of several parts.  The anterior cingulate gyrus, often considered part of the limbic system, is responsible for focusing and shifting attention.  The dorsal lateral and inferior orbital areas are in charge of time management, judgment, impulse control, planning, organization, and critical thinking.  The inferior orbital area controls behavior, sustains one’s attention span by focusing on important information, sends quieting signals to the limbic and sensory areas of the brain and suppresses impulsive behaviors.  The dorsal lateral horn area enables one to feel and express emotions such as happiness, sadness, joy, and love and translate the feelings of the limbic system into the higher emotions of love, passion and hate.  The basal ganglia integrates one’s feelings, thoughts, anxiety levels, smoothes motor behavior and modulates motivation.  [Amen 2001; 87, 89-92]

            Type 2—Inattentive ADD is the second most common type and is more commonly seen in girls.  This also involves decreased levels of dopamine leading to decreased activity in the prefrontal cortex, especially when concentrating.  [Amen 2001, 93]

            Type 3—Overfocused ADD is the third most common type, which is frequently found in substance abusers and the children and grandchildren of alcoholics.  This is characterized by excessive activity in the anterior cingulate gyrus, which allows one to shift from one thought to another.  The sufferer becomes locked into negative thoughts and behaviors and displays many of the same symptoms seen in obsessive/compulsive disorders.  The anterior cingulate gyrus is heavily innervated with serotonin neurons.  Stimulants such as Ritalin worsen the symptoms.  Serotonin medications such as Prozac and Paxil may help with the overfocusing, but cause problems with motivation, and can lead to an increase of angry and aggressive feelings.  [Amen  2001, 246-247]

            Type 4—Temporal Lobe ADD is commonly associated with severe behavioral problems.  Tasks requiring concentration cause decreased activity in the temporal lobes and reduced blood flow to the prefrontal cortex.  This is commonly associated with domestic violence and suicide, and is highly correlated with previous head injuries.  The dominant (usually left) side temporal lobe is involved with understanding, processing and retrieval of language or words; intermediate- and long-term memory, complex memories, emotional stability, and processing visual and auditory stimuli.  The non-dominant (usually right) side temporal lobe is concerned with reading facial expressions, processing verbal tones and intonations, hearing rhythms, appreciating music, and visual learning.  [Amen 2001, 113-117]

            Type 5—Limbic ADD is where ADD and depression intersect.  There is decreased prefrontal cortex activity both at rest and during concentration, while there is too much activity in the deep limbic area leading to negativity and depression.  On SPECT imaging, depression looks similar except that it improves with concentration, while ADD does not.  The front half of the hypothalamus sends calming signals through the parasympathetic nervous system, whereas the back half sends stimulating or fear signals through the sympathetic nervous system.  There is an intimate connection to the prefrontal cortex that involves switching between emotional and rational thoughts in the decision making process.  This type of ADD is often responsible for failed marriages as the decreased sexual interest, tiredness, feelings of being constantly overwhelmed, and lack of attention to detail causes marital conflict.  [Amen 2001; 131-135, 140]

            Type 6—“Ring of Fire” ADD is the most intense type.  There is too much activity across the whole cerebral cortex, especially in the cingulate gyrus, parietal lobes, temporal lobes, and the prefrontal cortex.  This results in severe overfocus symptoms:  worrying, obsessiveness, oppositional behavior, cognitive inflexibility, distractibility, hypersensitivity to touch, sounds, tastes, smells, and sights; mood instability and rages.  Psychostimulants such as Ritalin cause the sufferer to be more worried, irritable, and negative.  [Amen 2001; 141, 143, 145]

            According to the research of psychiatrist Joseph Biederman at Harvard University, 52 percent of untreated ADD/ADHD adults abuse drugs or alcohol as a form of self-medication.  People use them so that they may feel more focused, less anxious, less overwhelmed, and less depressed.  However, ultimately this makes the symptoms worse, beginning the downward spiral to addiction.  Eventually there is a decrease in brain activity, which is sometimes drastic, with the continued use of cocaine, methamphetamines, marijuana, alcohol, nicotine, and caffeine.  Doctor Ismael Mena at UCLA found 23 percent less brain activity in cocaine addicts, while those that also smoked cigarettes had 45 percent less activity in their brains.  Heroine, opiates, painkillers, and tranquilizers are rarely abused because these generally are not stimulating enough to quell the ADD/ADHD symptoms.  Types 1 and 2 ADD tend to abuse stimulants such as cocaine and methamphetamines, Type 3 ADD tends to abuse alcohol, Types 4 and 5 ADD tend to be marijuana and stimulant abusers, and Type 6 ADD tends to abuse alcohol and marijuana.  Cocaine and methamphetamines are used so that they may feel more energetic and focused, while alcohol and marijuana tend to settle the feelings of internal restlessness.  [Amen 2001, 171-172]

ADD/ADHD AND THE FIVE ADDICTIONS

            Addiction is the compulsive use of a substance or behavior even though the user knows the harm that will be done.  Many individuals with ADD/ADHD plunge into addictive and obsessive/compulsive behaviors because of their underlying neurology.  Unable to hold back the constant rush of thoughts or to effectively sort out individual ideas, they react impulsively.  They frequently seek exciting activities to relieve the overpowering feeling of boredom and temporarily achieve a sense of being alive.  Rituals and addictive behaviors commonly develop to deal with their impulsive, compulsive, frustrated, and anxious feelings.  Because many feel negative much of the time, they are easily victimized by offers of temporary pleasure that may ultimately lead to tragic or even fatal consequences.  [Gross 1997, 8]

            Addictionologists recognize five types of addiction:  compulsive use of drugs/chemicals, compulsive eating, compulsive gambling, compulsive sex, and compulsive work.  Kenneth Blum, Ph.D. has united these into the Reward Deficiency Syndrome as they all have a common basis in the expression of the A1 allele variant of the DRD2 dopamine receptor gene.

DRUG ADDICTION

             According to estimates, 20 percent of people in the United States have chemical addictions.  The United States Office of Drug Control Strategy estimated that there were 2.1 million cocaine users and 600,000 heroin users in America in 1994.  Addictions and/or substance abuse have been related to over 80% of crimes.  The leading causes of death in the United States are addiction related as seen in 69% of drownings, 68% of manslaughters, 49% of murders, 50% of traffic fatalities, and 35% of suicides.  These figures do not even include those deaths directly related to drug overdoses or drug abuse complications.  [Leviton 1995, 14]

            General Barry McCaffrey (Director of the Executive Office of the President’s White House Office of National Drug Policy) stated in 1997 that drug and addiction problems should become the nation’s top priority because:

·        Our drug problem costs $70 billion per year;

·        More than one-half of all persons brought into the criminal justice system suffer from addiction;

·        3.5 million Americans are chronic drug users;

·        1 million Americans are in addiction treatment;

·        The leading cause of death in the United States is drug related;

·        45% of us know someone who suffers from addiction;

·        Drug use by 8th graders is up 150%;

·        11% of all children between 12 & 17 used illicit drugs in the past month;

·        Kids who smoke marihuana are 85 times more likely to use cocaine;

·        82% of all people who try cigarettes do so by age 18;

·        4.5 million children smoke;

·        3000 children per day start cigarette smoking;

·        1 million drug arrests are made per year;

·        60% of all federal prisoners are drug offenders;

·        31% of all felony convictions in 1994 were drug offenders;

·        75% of all prison growth since 1980 is due to drug offenders;

·        Heroin production is up 60% at 375 metric tons;

·        There are more people in prison than the military;

·        The U.S. has the highest rate of drug use of any nation;

·        Every man, woman, and child pays $1000 per year for our drug problem.  [White House 1997]

ALCOHOLISM

             A review of the literature leads one to conclude that alcoholism is a disease resulting from a brain dysfunction.  [Maltzman 1994]  Using SPECT imaging of the brain, Amen and associates concluded that alcohol and other drugs interfere with the higher order brain functions and can lead to increased aggressive behaviors.  They also concluded that using drugs and alcohol might be an attempt at self-medication to calm the aggressive behavior related to the brain dysfunction.  A National Institute on Alcoholism survey in 1992 found that as many as 13.7 million Americans over the age of 18 are alcoholics.  [Amen et al. 1997]

            Blum’s research proposes a biogenetic foundation to the concept of alcoholism as a disease.  He demonstrated that the A1 allele variation of the DRD2 dopamine receptor gene affects a person’s individual biology, not only leading to alcoholism, but also to the possible abuse of psychoactive drugs.  [Blum 1991]  Alcoholism and substance abuse disorders have many causative factors that probably involve multiple genes.  The diagnosis, treatment, and prevention of these disorders should be recognized and taken care of by both biogenic and psychogenic approaches.  [Pickens et al. 1991; Blum 1991]

            A cDNA construct of the dopamine D2 receptor gene was used to prove the connection between this gene and alcohol consumption in rats.  The cDNA construct was implanted into the nucleus accumbens of rats which had been bred to prefer alcohol to water.  After four days of treatment, the alcohol consumed by these rats decreased 50% while dopamine D2 receptors had increased by 150%.  Dopamine D2 receptor density and alcohol consumption returned to their initial levels after eight days of non-treatment.  This experiment was then duplicated twenty-four days later with the same outcome.  [Volkow 2000]

COMPULSIVE EATING

            Approximately 60 million people in the United States are obese, weighing over 20% more than their ideal weight.  This puts them at risk for developing high blood pressure, strokes, heart disease, and diabetes, accounting for nearly 300,000 deaths annually.  The decreased number of dopamine D2 receptors in the limbic system is often the cause of this problem, as these people lack a sense of well-being.  They may turn to compulsive eating, particularly carbohydrate bingeing, as their way of coping, with the resultant obesity. 

            Unfortunately, many resort to appetite suppressant drugs such as Phentermine HCl which alter the effects of serotonin in the limbic system, thereby providing a sense of satiety.  The Physician’s Desk Reference [1997] advises that this drug can be habit forming, is not a replacement for a program involving proper diet and exercise, and should not be used for more than eight to twelve weeks.  Few doctors or their patients follow these caveats.

            The stimulant Fenfluramine, was combined with the appetite suppressant Phentermine HCl to create the popular diet drug Fen-Phen.  Fenfluramine and other methamphetamines have been found to cause the death of serotonergic nerves in animals.  [Battaglia et al. 1987; Psychiatric Times 1995; Psychiatric News 1997]  Researchers have also connected it with heart valve dysfunctions and a crippling lung condition that can be fatal.  In 1996, JAMA warned doctors that the Fen-Phen combination, when given in doses equivalent to those prescribed for humans, triggered brain damage in monkeys and rats.  [Nightengale 1996]

            Eating behavior is regulated not only by neuropeptides such as the pancreatic polypeptides, hormone releasing factors, gut-brain peptides, and opioid peptides but also by neurotransmitters such as dopamine, norepinephrine, epinephrine, serotonin, and the amino acid gamma-aminobutyric acid, all of which are involved in the Brain Reward Cascade.  [Blum et al. 2000, 33]  The dysfunction of any of these neuropeptides or neurotransmitters can lead to compulsive eating.

COMPULSIVE GAMBLING

            Gambling becomes an obsession when a person risks money or other possessions for a greater payoff.  An impulsive craving develops for any type of gambling that will produce a state of euphoria similar to a cocaine high.  Like alcohol and drug abusers, ever increasing levels of stimulation are required as tolerance is developed through repetition.  Taking bigger and bigger risks to attain a state of euphoria, the gambler shows the same withdrawal symptoms of a drug addict when not able to gamble.  [Volberg and Steadman 1988]  The gambler advances through the four stages frequently seen in other addictive behaviors:  winning, losing, desperation, and hopelessness.  The combination of compulsive, impulsive and addictive behaviors seen in compulsive gambling is sometimes described as a “pure addiction” since no foreign substances are ingested into the body.  Often there are other co-disorders seen with compulsive gambling such as ADHD, alcohol or drug abuse, depression, manic/depressive disorders, narcissistic personality disorder, antisocial personality, and schizoid/avoidant behavior.  [Blum et al. 1995c]  The A1 allele of the DRD2 dopamine receptor gene has been found in 50.9% of Caucasian pathological gamblers, and in 76% of male gamblers that also abuse drugs.  [Comings et al. 1996b]

COMPULSIVE SEX

            Very little research has been published about compulsive sex disorders, even though it is acknowledged as one of the five addictive behaviors characterized by the presence of the A1 allele of the DRD2 dopamine receptor gene.  The foremost leaders in sex research, Masters and Johnson, have very little to say on the subject.  Their landmark text, Masters and Johnson on Sex and Human Loving, states:

People with extraordinarily high sex drives, which are insistent and persistent but rarely lead to more than fleeting gratification or release despite numerous sex acts with numerous partners, are considered to be hypersexual or “oversexed.”  In women, this condition has been called “nymphomania”; in men, it is called “satyriasis” or “Don Juanism.”

            There has been little scientific study of these conditions, which often seem to be considered more of a joke than anything else.  There are no absolute criteria for defining hypersexuality.  The central features of most studied cases are that (1) sexual activity is an insatiable need, often interfering with other areas of everyday functioning; (2) sex is impersonal, with no emotional intimacy; and (3) despite frequent orgasms, sexual activity is generally not satisfying.  [Masters, et al. 1985, 391]

            Those with sexual compulsions exhibit the following twelve characteristics:

1. They have few healthy sexual boundaries.  They become sexually involved with and/or emotionally attached to people without knowing them.
2. Because they fear abandonment and loneliness, they stay in or return to painful, destructive relationships.  They grow more isolated and alienated from their friends and loved ones as they conceal their dependency needs from others and even themselves.
3. Because they fear being deprived emotionally and/or sexually, they compulsively pursue one relationship after another, sometimes even having several sexual liaisons at one time.
4. They confuse neediness with love, physical appeal with sexual attraction, pity and/or neediness with rescue or being rescued.
5. When alone, they feel empty and incomplete.  While fearing intimacy and commitment, they are constantly searching for relationships and sexual contacts.
6. They sexualize stress, guilt, loneliness, anger, fear, and envy.  They use sex as a substitute for nurturing, care, and support.
7. They use sexual involvement to manipulate and control others.
8. They become seriously distracted or even immobilized by romantic or sexual obsessions or fantasies.
9. They avoid personal responsibility for themselves by attaching themselves to people who are emotionally unavailable.
10. They are enslaved to emotional dependency, romantic intrigue, and compulsive sexual activities.
11. To avoid feelings of vulnerability, they retreat from all intimate involvement.  They mistake sexual and emotional anorexia for recovery.
12. They assign magical qualities to others, idealizing and pursuing them, and then blaming them when the others cannot fulfill their fantasies and expectations.

            Further compounding their problems, these actions continue to repeat themselves because the people with sexual compulsions cannot find satisfaction, self-fulfillment, and a sense of well-being.  They demand ever increasing stimulation to achieve a temporary sense of well-being, just like any other addiction.

COMPULSIVE WORK

            Even less has been published about compulsive work or workaholism, than about sexual compulsions.  In the Western culture, this is the one obsessive/compulsive behavior that is actually regarded with admiration and respect.  Because the workaholic is so focused on achievements, accomplishments, and/or economic success, it is seldom recognized that many also have ADHD.  [Gross 1997, 136]  Often workaholism is strongly linked with the behaviors displayed in compulsive gambling.  They often get a “charge” from their work, while sacrificing their relationships with their family and friends.  Like any other addiction, it requires more and more activities or accomplishments to achieve the same temporary level of well-being.  All other activities including eating and sleeping are shoved aside while making the next deal, winning the next challenge, and beating one’s competition.  No triumph or level of achievement is ever enough.  They can never find more than fleeting happiness or satisfaction, because they believe they could have achieved more if they had only strived a little harder.

            When the challenge of a project is over, or it is time to stop working, the workaholic “crashes” with exhaustion.  He or she may become irritable, or just too tired to stay awake any longer.  If they allow themselves the luxury of non-work or non-project days, workaholic men and women commonly wake up quite slowly, just like other ADD/ADHD individuals.  [Monroe 1997, 116-117]  In addition, many binge on carbohydrates or employ caffeine and/or nicotine to keep up their energy levels.  When this no longer works, they may move on to even more potent stimulants.

OBSESSIVE/COMPULSIVE DISORDERS

            Psychologists identify many different obsessive/compulsive disorders.  What each of these disorders share is an intense anxiety due to recurring unwanted intrusive ideas or impulses (obsessions), in conjunction with recurring behaviors (compulsions) which are used to lessen the anxiety.  These thoughts and impulses are recurring, disturbing and troubling, occasionally injurious, and very challenging to overcome.  The sufferers gravitate toward repetitive behaviors such as checking and rechecking repeatedly, repeating a phrase over and over, repetitive washing, counting (often while performing another repetitive behavior such as washing), incessantly rearranging objects to keep them aligned exactly, and hoarding items.  Many perform very disciplined rituals, while others have complicated rituals that change with time.  These behaviors make no sense to anyone else observing them, though they do offer the sufferer some temporary relief from their feelings of anxiety.

            Typically, the person suffering from an obsessive/compulsive disorder will have feelings of anxiety and anger, aggressiveness, low ego strength, an inability to cope with the daily stresses of living, and a craving for substances and/or behaviors that will temporarily ease these symptoms.  They may retreat to using alcohol, mind-altering drugs, or compulsive behaviors such as eating (especially carbohydrates), gambling, sex, or workaholism, depending on what is available or morally acceptable to them.

            Those with the A1 allele of the DRD2 dopamine receptor gene are also more vulnerable to stress-related disorders.  Researchers observed that 59 percent of Vietnam veterans suffering from Post-Traumatic Stress Syndrome possess the A1 allele compared to 5 percent of veterans who were subjected to similar stress but did not develop the disorder.  [Comings et al. 1996]

            Stress-related disorders can also be seen in conditions such as sleep disorders, anxiety, depression, mania, bipolar disorder, phobias, panic attacks, somatization, and even irritable bowel syndrome and some immune disorders.  Often these are seen as co-morbid disorders along with the obsessive/compulsive and addictive behaviors.  Please refer to Figure 3 for a better understanding of the neuro-chemistry that is involved in the Reward Deficiency Syndrome Family of disorders.

            Clearly, there are a lot of unhappy people who are not able to achieve a sense of well-being.  Pleasure seeking and the handling of anxiety and stress, have their physiological foundation in the interaction of the neurotransmitters that “cascade” in the limbic structures of the brain, the dorsal horn of the spinal cord, and the dorsal roots of the spinal nerves, ultimately releasing dopamine in the D2 receptors.  [Blum 1989; Stein and Belluzzi 1986]  The deficiencies of the neurotransmitters and enzymes regulating the proper balance in the Brain Reward Cascade, leads to the craving for substances or mind-altering experiences to stimulate the release of dopamine and achieve this sense of well-being.  The most destructive approach to coping with this lack of well-being is to self-medicate with alcohol or drugs.  The symptoms may momentarily disappear, making life appear more enjoyable and easier to deal with, but this is only a fantasy.  Life quickly becomes a nightmare as the addiction rapidly takes over.  [Faraone et al. 1991]

VERTEBRAL SUBLUXATION CORRECTION FOR

OBSESSIVE/COMPULSIVE AND ADDICTIVE BEHAVIORS

            Drug addicts generally fare poorly, many dying without treatment.  Only 1 out of 36 is fortunate enough to begin a treatment program for addiction.  [Leviton 1995, 15] 

            Three prime components are observed in obsessive/compulsive and addictive behaviors:  the physiological consequences, the psychological aspects, and the spiritual effects.  Not only is the individual distressed by these problems, but they have a substantial impact on the whole family and ultimately the entire community.

            An individual’s maladaptive behavior may be exhibited as:

·        an inability to learn and display appropriate social and academic skills;

·        an inability to associate behaviors with consequences and the inability to anticipate and accept consequences for behavior;

·        an inability to demonstrate cortical or impulse control;

·        an indication the person is of danger to himself, to others, to the family unit, or to property;

·        psychological or physical dysfunction and the development of antisocial behaviors which are a danger to the individual and the community; and

·        oppositional defiant behavior, conduct disordered behavior, generalized anxiety disorder, depression, dysthymia (despondency), behavior disorders, or specific developmental disorders.

            Those individuals with emotional or personal maladaptive behaviors that are often observed in a Reward Deficiency Syndrome treatment program originate from:

·        a failure to develop a sense of being worthwhile;

·        developing a sense of not belonging (even a sense of not belonging in their family);

·        failing to develop skills of self-reliance and independence;

·        developing an external locus of control (feelings as if all the control in his life is outside of himself, feeling as if others or outside forces determine the rules and outcome in his life);

·        developing an adjustment style characterized by withdrawing from social interaction, responsibility, and at times even family members; and

·        the development of numerous psychophysiological reactions to psychosocial stressors.

            Some of the socially maladaptive behaviors which we see originate with these persons include:

·        developing a poor set of social skills (failing to develop the ability to interact smoothly and comfortably with others);

·        failing to develop and be guided by a strong sense of what is right and wrong, or what is good or bad;

·        developing and accumulating a strong sense of anger which may be expressed indiscriminately and in less than modulated terms;

·        developing poor family relations;

·        developing poor school relations (with the school as an institution, with the teachers in the school, and with peers at school); and later, poor work relations (with the work as an institution, with the supervisors on the job, and with coworkers in the work environment); and developing poor relations within the community.  [Blum 2000, 61]

            Feelings are mediated in the limbic system involving the amygdala, the nucleus accumbens, the hypothalamus, the dorsal horn of the spinal cord, and the spinal nerve’s dorsal roots.  [Pert and Diensfrey 1988; Lewis 1981]  The Brain Reward Cascade theory has been proposed to explain the neurochemical cascade that ends with dopamine activating reward centers that result in the feelings of well-being.  [Blum and Kozlowski 1990]  Researchers have found neuropeptide receptors in the dorsal horn of the spinal cord and/or the dorsal roots of the spinal nerves that have psychophysiological effects.  Therefore, the spinal cord should be considered an anatomical extension of the limbic system since many of a person’s feelings, emotions, and their reactions are mediated right in the spinal cord and its nerve roots, not just in the brain as previously thought.  [Pert and Diensfrey 1988; Lewis 1981; Blum and Kozlowski 1990]  According to research done at the Harvard Medical School Department of Neuro-Biology, there are neurons in the spinal cord which project directly to the amygdala and the orbital cortex.  These neurons facilitate the transfer of somatosensory information, including pain sensation, which ultimately affects the autonomic, endocrine, and behavioral functions.  [Burnstein and Potrebic 1993]   Specific spinal pathways have been discovered which carry nociceptive information directly to the limbic system and the hypothalamus.  [Giesler et al. 1994]

            Clinically, it has been known that Chiropractic care has beneficial health effects far beyond the care of musculoskeletal disorders; however, published research is rare.  Data was collected from 2819 participants under the care of Chiropractors utilizing Network Chiropractic Technique.  The participants filled out self-rated wellness and quality of life surveys which revealed overall increased feelings of well-being.  Even after three years of care, some reported continuing ongoing improvements and feeling better overall.  [Blanks et al. 1997]

            Holder and Blum tested the hypothesis that a subluxation-free spine facilitates dopamine release in the reward centers of the nucleus accumbens, dorsal horn of the spinal cord, and dorsal roots of the spinal nerves, producing an increased sense of well-being.  They did their research in Miami, Florida at the Exodus Treatment Center to see if they could significantly impact the addicts’ withdrawal from drugs, improve their psychological states, and increase the patient retention rates in a program for inpatient substance use disorders.  For this trial, they developed the Integrator adjusting instrument, so that they could consistently deliver a calibrated thrust with the option of torque.  [Blum et al. 2000; Holder et al. 2001]  This would prove to be a real proving ground for the efficacy of Chiropractic care since chemicals are one of the major causes of vertebral subluxations:  20% of American’s suffer from addictions, and 83% of all crimes are drug-related.  [Holder 1998]

            Ninety-eight subjects were divided into three groups for the 1½-year randomized, blinded clinical trial of subluxation-based Chiropractic care.  The first group was a standard residential treatment group that included using the Integrator adjusting instrument and the Torque Release protocol to correct vertebral subluxations.  The second group was a standard residential treatment group who were given placebo Chiropractic adjustments using the Integrator adjusting instrument set on zero thrust.  The third group was a standard residential treatment group following the general policies of the residential program.

            Robert Duncan, Ph.D., of the University of Miami School of Medicine found that in the thirty day residential model, those receiving Chiropractic subluxation correction had a 100% retention rate, those receiving placebo Chiropractic care had a 75% retention rate, and those in the standard treatment group had a 56% retention rate.  At the end of the program, the Spielberger State Anxiety scores were 32.0 + 1.5 for those receiving Chiropractic subluxation correction, 42.5 + 3.0 for those receiving placebo Chiropractic care, and 33.1 + 3.7 for those receiving the standard treatment.  A battery of seven psychological inventories revealed that four weeks of Chiropractic care was more effective than one year of the standard medical treatment for depression related to addiction.  For anxiety, four weeks of Chiropractic care was more effective than six months of the standard medical treatment.  During the thirty day program, only 9% of those receiving Chiropractic subluxation correction made one or more visits to the nursing station, compared to 56% of those receiving placebo Chiropractic care, and 48% of those receiving the standard treatment.

            Chiropractic subluxation correction has demonstrated phenomenal results in reducing anxiety and depression, decreasing costs, increasing retention, and increasing the overall results for the chemically addicted in residential treatment programs.

            Holder has been achieving even more extraordinary results in his addiction treatment program by joining five modalities together:  Chiropractic subluxation correction, amino acid precursors for the neurotransmitters in the Brain Reward Cascade, ear acupuncture, counseling, and the Alcoholics Anonymous program.  He states that for each dollar invested, Chiropractic offers the greatest patient benefit. 

            According to Holder’s hypothesis, when the spine is subluxated, the spinal nocioceptive reflex interferes with the biochemical sequence of neurochemicals in the Brain Reward Cascade, that result in one’s sense of peace, calm, self-esteem, and well-being.  Instead, the person will be subjected to disturbing emotions and anxiety, and will begin to crave mind-altering substances and/or experiences that will change, relieve, or suppress these feelings.  [Nelson 1994]  The brain and spinal cord function as one unit, they are one and the same; the receptors that mediate emotions in the limbic system of the brain are also exactly the same ones that are found in the dorsal horn of the spinal cord and the dorsal roots of the spinal nerves.  The limbic system is where one’s sense of well-being and other emotions are situated.  The Brain Reward Cascade takes place throughout the limbic system, including the spinal cord and nerve roots.  [Pert and Dienstfrey 1988]

            Drugs and chemicals, especially the addictive chemicals, can create a vertebral subluxation by depleting the specific neurotransmitters in the limbic system, thereby interfering with the Brain Reward Cascade.  Physical trauma, mental/emotional traumas and stress overloads, thermal distress, and genetic defects can also cause vertebral subluxations resulting in interference to the Brain Reward Cascade.  A state of well-being cannot exist when vertebral subluxations are present.  When a vertebral subluxation is corrected, the Brain Reward Cascade can function normally, achieving a sense of well-being.  Addictive substances or mind-altering behaviors will no longer be needed as temporary compensations.

            While the Chiropractic adjustment removes the interference with the natural flow of neurotransmitters in the Brain Reward Cascade, it is vital to shore up the neurotransmitter’s precursor amino acids in the body.  In the chemically dependent, Holder uses 750 mg L-phenylalinine, 750 mg D-phenylalinine, 750 mg L-glutamine, and 750 mg L-tyrosine daily for a minimum of one year.  [Holder 2001]  These amino acids, and L-phenylalanine in particular, reduce stress significantly, lift depression, and restore the body’s sense of well-being by rebuilding the Brain Reward Cascade.  [Leviton 1995, 15-16]  It appears that the dopamine D2 receptors will regenerate with time.  For those with ADD/ADHD, this combination of amino acids should be continued indefinitely.  Holder would also add 500 mg L-tryptophan daily to this program if it were not banned by the FDA.  There is a great deal of debate as to whether 5-hydroxy tryptophan can be used as a substitute for L-tryptophan and whether the body can convert it as needed.  If 5-hydroxy tryptophan is used, it should be at only 1/10th the dose of L-tryptophan.

            Blum’s research on amino acids has found that glycine promotes sleep, L-phenylalanine is very stimulating and helps to improve attention, L-methionine works as a natural antidepressant, L-leucine performs as a daytime anti-anxiety agent, and L-taurine offers the greatest relaxation with sedation while having no effect on the brain’s alpha wave activity as the other amino acids do.  [Blum 2000]

            The typical medically based residential treatment program for drug addiction costs an average of $16,000 per person per month in 1995.  Nationally, only 72% of participants complete the typical thirty day medical program, with many relapsing into addiction within a year.  In contrast, Holder’s program costs approximately $1000 per addicted person for one month of care, with an almost 100% retention rate, and virtually no relapses within one year.  His program includes twenty Chiropractic adjustments over a thirty day period at a cost of $600, four addiction counseling sessions costing $240 to $400, and $30 for one month’s supply of amino acids.  [Leviton 1995, 17]

             For this research study, Dr. Holder needed to reproduce the Chiropractic thrust given by hand.  He had to be able to duplicate the force and depth of the thrust, while having a consistent torque, to rule out differences in the application of the spinal adjustments.  For this, he developed the Integrator; a hand-held spinal adjusting tool that can also apply the component of torque.  The instrument is set to thrust when a predetermined loading is reached, so that differences in pre-stressing and pre-loading are not present during the spinal adjustment.  Using the Integrator adjusting instrument along with the subluxation analysis systems from several Chiropractic techniques, he developed the Torque Release Technique of subluxation analysis and correction. 

            According to the Torque Release Technique, at any given moment there is only one vertebral subluxation that should be adjusted.  Although vertebral subluxation indicators may be present at a particular level, this may not be the most appropriate place to adjust at the moment.  It should be the Chiropractor’s purpose to find the window into the nervous system by testing for the appropriate segment, finding the proper direction to apply the force, and determining what direction the torque may need to be applied.

            Because the nervous system records and memorizes every input and event, a non-sequential adjusting procedure should be used for each office visit.  Otherwise, by inducing a repetitious pattern into the nervous system, the patient may become addicted and rely on the doctor’s pattern of spinal manipulation rather than promoting change and progressing in their healing through the Chiropractic adjustment.  The predominant vertebral subluxation affecting people’s health, preventing them from expressing their full potential, and fully experiencing a state of well-being, is from neural tension rather than pressure on the nervous system, according to Holder.  [Nadler, Holder, and Talsky 1998]

            Conventional medicine cannot offer the drug-free approach to health and healing bestowed by Chiropractic care for the addicted and/or obsessive/compulsive patient.  The mood-altering and mind-altering drugs prescribed by psychiatrists only reinforce addictive and obsessive/compulsive behaviors, forcing the patient to become dependent on still another chemical substance in order to feel better.  The “feeling good” pathways of the Brain Reward Cascade can be rebuilt, thereby breaking the cycle of addiction to chemicals and/or obsessive/compulsive behaviors.  True healing can finally take place when subluxation-based Chiropractic care releases the chronic tension in the nervous system and when the proper nutritional protocols are followed to adequately supply the necessary neurotransmitters.

ADD/ADHD TREATMENT

            There is the story of the six blind men who are examining an elephant for the first time.  The first blind man feels the leg and describes the elephant as being big, scaly, and round like a tree.  The second man touches the ear and claims that an elephant is like a giant fan.  The third examines the body and says an elephant is like a large, rough wall.  Another studies the tusk and asserts an elephant is like a spear. The next analyzes the long, tubular trunk emitting warm arm and declares that an elephant is like a hose.  The final blind man scrutinizes the tail and avows that an elephant is like a whip.

            ADD/ADHD likewise does not have a concise definition or standard of treatment.  Defining ADD/ADHD from their own perspective, each profession relies on descriptions that focus on one part or another of the syndrome to define it:  the psychologist—a mental disorder, the medical doctor—a lack of certain chemicals, the neurologist—a brain dysfunction, the nutritionist—a lack of certain nutrients, the teacher—a discipline problem, the Chiropractor—interference in the nervous system.  [Hallowell and Ratey 1994, 151]  As pointed out by psychologist Abraham Maslow, people almost always frame problems in terms of the tools or experience they can offer as the solution.  [Hartmann 2000, 174]  “When the only tool you have is a hammer, everything in the world looks like a nail.”  Each one’s therapy has some success with some of the aspects, but when they extend it to all the forms of ADD/ADHD, they are astonished at their failures.

EFFECTS OF RITALIN AND OTHER STIMULANTS ON BEHAVIOR

            In spite of the opinion of the pharmaceutical industry, ADD/ADHD is not a deficiency of Ritalin in the blood.  Because ADD/ADHD sufferers have the same neurochemical imbalance that predisposes them to other impulsive, compulsive, and addictive behaviors, it may well be very harmful to give them cocaine-like surrogates like Ritalin.  ADD/ADHD is just a list of symptoms, and the only way drugs help is by covering up and suppressing those symptoms.  The underlying causes are not identified, eliminated, or corrected.  The symptoms return as soon as the drugs are discontinued.  Medication is a short-term answer to the long-term symptoms, with serious side effects.  A group of researchers discovered that despite eight years of medications, behavioral modifications, and educational adaptations, 80 percent of the ADD/ADHD children in their study had persistent symptoms.  Twenty percent of the participants did not receive any medication.  After eight years, only 20 percent of the children showed improvement (the study does not indicate if these were the same 20 percent that did not take medication).  [Barkley et al. 1990]

            Stimulants suppress all spontaneous behavior, causing obsessive-compulsive behaviors such as focusing on something boring to the exclusion of everything else, and repeating boring tasks over and over.  Stimulants impair the brain’s functions, producing apathy, compliance, and robotic submission to boring activities.  Over-stressed parents and teachers often view the child’s subdued and obsessive behavior as an improvement rather than as a negative drug effect.  [Breggin 2001; 14, 283]  Twenty-five percent of children taking Ritalin develop obsessive/compulsive disorders according to the research of Borcherding and Castellanos.  Further, Solanto and Wender discovered that 42 percent of children given only one dose of stimulant drugs, developed an obsessive over-focusing, sometimes being unable to stop performing assigned tasks.  [Breggin 2001, 37]

            Ritalin and amphetamines can cause severe withdrawal symptoms such as excitability, hyperactivity, and euphoria; or exhaustion, irritability, depression, psychosis, and suicidal feelings.  The typical parent will not be aware of the withdrawal reaction their child may be going through after missing even a single dose.  When their child is suffering from withdrawal, they may mistakenly believe that their child needs to be put back on the medication, or may even need an increased dosage.  [Breggin 2001, 105]

            Between 25 and 40 percent of ADD/ADHD children do not respond to medication.  Of those who do respond to medication, a large proportion respond to a placebo as well.  An extensive review done on ADD/ADHD children, discovered that while stimulant medications exhibit short-term benefits for managing the behavioral symptoms of inattention, impulsivity, and hyperactivity; they lack any long-term effects on learning, academic achievements, athletic skills, antisocial behaviors, and arrest rates.  [Swanson et al. 1993]

            Rie’s research team found that Ritalin interferes with learning:   while Ritalin suppressed “disapproved behaviors” that can hamper learning, it also suppressed the “desirable behaviors that facilitate it”.  Their double-blind study of 28 children given Ritalin or a placebo for twelve weeks proved that even when there was improved behavior, there was no improvement in scholastic achievement.  Spontaneous behavior was suppressed along with a flattening of the emotions.  The children became:

distinctly more bland or “flat” emotionally, lacking both the age-typical variety and frequency of emotional expression.  They responded less, exhibited little or no initiative and spontaneity, offered little indication of either interest or aversion, showed virtually no curiosity, surprise, or pleasure, and seemed devoid of humor.  Jocular comments and humorous situations passed unnoticed.   In short, while on active drug treatment, the children were relatively but unmistakably affectless, humorless, and apathetic.  [Rie et al. 1976]

            Teachers on the other hand, erroneously confused these behavioral changes with improvements in learning.  [Breggin 2001, 49]  One research team noted that ADD/ADHD children showed improved academic performance while receiving low doses of stimulants, but were given low marks for behavior.  When given higher doses, they received higher marks for behavior but lower marks for academic performance.  [Sears and Thompson 1998, 249]  Teachers seem to believe that children learn better when they sit quietly.  While taking stimulant medication, they do sit more quietly, but are not necessarily learning.  As one pharmacologist noted:  "The child on stimulant medication is staring like a deer caught in the headlights of a car...and the teachers call it concentration."  In the words of one teen, "I don't pay attention any better, but at least I don't get yelled at any more!"  When hyperactive children were given Ritalin, it apparently restricted their creative thinking as they seemed overly compliant and offered less varied answers to open-ended questions.  [Feidler and Ullman 1983]  Medication may cover up the undesirable behaviors in the hyperactive child, but the underlying neurochemical problems have not been solved.

            In his book, Talking Back to Ritalin:  What Doctors Aren’t Telling You About Stimulants and ADHD, Peter R. Breggin, M.D., points out how treating ADD/ADHD can begin the downward spiral into “polypharmacy”:

First the child is put on Ritalin or Adderall for minor school or family problems.  When the stimulant causes insomnia, a sedating drug like Klonopin (clonazepam) or clonidine is added at night.  When the drug combination makes the child depressed, an antidepressant like Prozac or Paxil is added.  When the three drugs impair the child’s emotional stability, making him aggressive and unpredictable for the first time, the parents are told that their child’s “bipolar” or “manic-depressive” disorder has “emerged.”  Now lithium or Depakote is added as a “mood stabilizer.”  When this medically negligent over-dosing with four drugs leads to bizarre behavior, the child is put on an “antipsychotic” such as Risperdal or Zyprexa.

Of all the drugs that this child was prescribed, only the stimulants were FDA-approved for children.  Although the parents were not told, four out of five of the drugs were “off label” and the combination was wholly unjustified on any clinical or scientific grounds.  The “cocktail” of medications was guaranteed to ruin the child’s mental life and eventually to leave lasting harmful effects.  Yet this “polypharmacy” approach has become too commonplace.  [Breggin 2001, 7]

            Long-term studies have found that ADD/ADHD children remained impulsive as adults when medication was the only form of treatment.  As time went on, their impulsiveness became more ominous:  they changed addresses more often, changed jobs more frequently, were involved in more automobile accidents, and had more children out of wedlock than their peers.  [Hechtman 1996, 17-38]  Nadine Lambert, Ph.D., Professor of Cognition and Development and Director of the School Psychology Program at the University of California, Berkeley, along with Carolyn Hartsough concluded that childhood treatment for a year or more with stimulant medication “is significantly and pervasively implicated in the uptake of regular smoking, in daily smoking in adulthood, in cocaine dependence, and in lifetime use of cocaine and stimulants.”  [Lambert and Hartsough 1998; Lambert 1998]

            Politicians, teachers, and medical doctors misleadingly assert that if ADD/ADHD children are not put on Ritalin, they will “self-medicate” with illegal substances later in life.  [NIMH 2000; Stocker 1999]  Doctors have even been warning parents about studies showing that boys with ADHD have a higher incidence of criminal behavior and other problems in young adulthood.  This is extremely frightening to loving parents whose son may have the symptoms of inattention, hyperactivity, or impulsivity.  Many feel coerced into consenting to long-term Ritalin use for their child.  The truth of these studies is that the youths that grew up with these problems were being treated with Ritalin at an advanced no-cost research clinic.  [Mannuzza et al. 1991]  As Peter Breggin notes:  “These reports should discourage parents from handing over their children to the doctors.  They suggest that being diagnosed ADHD and being treated with stimulants leads to a long-term negative outcome for children.”  [Breggin 2001, 124-125]

            Peter R. Breggin, M.D., sums it up best in Talking Back to Ritalin:  What Doctors Aren’t Telling You About Stimulants and ADHD:

Drugs can make a child more obedient by making the child’s brain malfunction.  It is tragic that we often seem to prefer an impaired child to a child with a normal brain.

Drugs are only useful when we are focused on our needs as adults rather than on the needs of the child.  Every time we drug a child we are choosing our convenience and our peace of mind over the child’s real needs.  This is another reason never to use drugs.  It is unethical to drug a child for our own convenience.  It is wrong to distort the function of a child’s brain with drugs in order to “improve” the child’s behavior.  [Breggin 2001, 139]

EFFECTS OF RITALIN AND OTHER STIMULANTS ON THE NERVOUS SYSTEM

            Ritalin is not a weak stimulant as previously thought.  A typical childhood Ritalin dosage of 0.5 mg/kg blocks 70 percent of the dopamine transporters, while cocaine blocks only 50 percent.  [Volkow et al. 2001]

            Stimulants such as Ritalin, Adderall, and Dexedrine are lethal to brain cells.  [Huang et al. 1997]  Research on rhesus monkeys and other animals resulted in a permanent loss of dopamine receptors from relatively small doses of amphetamine consumed for only a few days or weeks.  The over-stimulation of the receptors by amphetamines causes a compensatory receptor die back.  [Wagner et al. 1980; Juan et al. 1997]  There is a permanent reduction of dopamine production after an initial amphetamine stimulus.  [Weiss et al. 1997]  One study showed that 38 days after stopping amphetamine consumption, animals treated twice daily across 5 weeks, displayed permanent structural changes in the nucleus accumbens and prefrontal cortex neurons.  [Robinson and Kolb 1997]  Positron Emission Tomography (PET) demonstrated drastically reduced dopamine synthesis and concentration of 55 to 85 percent up to 3 months after monkeys were given only two small doses of amphetamine (2mg/kg, four hours apart).  After 8 months, one monkey continued to show dysfunction, leading the researchers to conclude that even limited amphetamine usage produces long-lasting “neurotoxicity”.  [Melega et al. 1997]  Relatively small, short-term doses of amphetamine, also cause comparable permanent changes in the norepinephrine neurotransmitter system.  [Camp et al. 1997]  Other researchers have also verified that chronic methamphetamine exposure produces irreparable dopamine receptor loss and/or death of dopaminergic and serotonergic neurons in the brain.  [Schmued et al. 1997; Sheng et al. 1996; Sonsalla et al. 1996; Wagner et al. 1980; Zaczek et al. 1989; Battaglia et al. 1987; Breggin 1999a; Breggin 1999b] 

            It has been shown on autopsy that dopamine is depleted in the brains of methamphetamine addicts.  Because of the deterioration found, emotional disturbances are probable even though autopsy studies did not prove permanent degeneration.  [Wilson et al. 1996]  Team member Steven Kish acknowledged to the Toronto Star that the effects of long-term Ritalin usage “would logically be similar” in view of the fact that Ritalin is very similar to methamphetamine.  [Harvey 1996]

            After Ritalin is administered to animals, the dopamine receptors become less sensitive.  [Barnett and Kuczenski 1986]  Researchers have established that the percentage of neurons in the locus coeruleus decreased and the remaining neurons became less responsive to stimulation after treating rats with Ritalin for only seven days.  [Lacroix and Ferron 1988]  Short term Ritalin administration causes a reduced density of norepinephrine receptors.  [Mathieu et al. 1989]  Short-term Ritalin usage has a very disruptive impact on animal brains, but no long-term studies have been done of its damages.  [Juan et al. 1997]    The dopamine receptors undergo their greatest development during the preschool years.  Because Ritalin acts predominantly via the dopamine transporter protein, we should have the greatest trepidation about the greatly increasing numbers of prescriptions in this age group.  [Dougherty et al. 1999]  We really have to wonder what permanent damages will be seen with prolonged Ritalin usage after what we have learned from the research on amphetamine and methamphetamine.  Of 24 young adults given stimulant medication as children, over half suffered from brain tissue shrinkage.  [Nasrallan 1986]

CONCLUSIONS ABOUT USE OF RITALIN AND OTHER STIMULATANTS FOR ADD/ADHD

            It is this ADHD author’s humble opinion that Ritalin should never be given to children, but maybe it should be given to their parents, so that they can keep up with their kids.  And maybe it should also be given to their teachers, so that the teachers can keep up with their students rather than boring them to death.  In Daniel Zeidner’s letter to the editor of Pediatrics:

It has become increasingly apparent to me, and perhaps to other pediatricians, that a new syndrome exists among adults who teach our school-aged children:  Teacher Deficit Disorder, or TDD.  I have observed that this diagnosis should be made in the teacher when the following classic signs and symptoms exist among one or more of his/her students:  students who fidget in class constantly moving their fingers or legs, who do not pay attention, who frequently daydream, who do not complete their homework or classwork, and frequently get out of their seats.  When students exhibit these manifestations, the teacher should be diagnosed with TDD and, of course, should be medicated immediately with amphetamine or other drugs that should speed him/her up, thus making him/her…more dynamic and interesting to his/her students.  [Zeidner 1995]

            When giving mind-altering drugs to change a child’s behavior, as parents, teachers, and health care professionals, we have to ask ourselves:  “Is this treatment really for the well-being of this child, or is it merely for the convenience of us caregivers?”  The number of children diagnosed with ADD/ADHD grows yearly until now it is an industry out of control.  Doctors, family practitioners, pediatricians, psychologists, psychiatrists, neurologists, the pharmaceutical industry, tutors, and schools all own a piece of this huge industry.  And once a major American industry begins, it just keeps on growing.  The goal is no longer to fix the problem, but rather to continue to get paid well by treating the symptoms.  If the problems get fixed, there is no need for all of the money-making drugs and services.  [Block 1996, 14-15]  To quote Lawrence Diller:  “In the bad old days, there was a ready response to children who misbehaved in school—they were likely to be beaten into submission.  Rejecting that option, as we’ve rightly chosen to do, has created a double bind that I believe feeds into the ADD-Ritalin boom.  We’re no longer willing to intimidate children into compliance, but we might just be willing to drug them into it.”  [Diller 1998, 89-90]

            For additional terrifying information about the results of stimulant usage by youths, see the following articles in Insight magazine by Kelly Patricia O’Meara.

Doping Kids, June 28, 1999 http://www.insightmag.com/main.cfm?include=detail&storyid=215412,

and Prescription Drugs May Trigger Killing, September 2, 2002

http://www.insightmag.com/news/264851.html

CHIROPRACTIC CARE FOR ADD/ADHD

            The diagnosis of ADD/ADHD is based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).  If at least six of the nine criteria for inattention, or six of the nine criteria for hyperactivity and impulsivity are identified by the child’s parents, teachers, or doctor, the child will leave the medical doctor’s office with a psychostimulant prescription and a new mental disorder categorization.  The medical model for ADD/ADHD treatment is based on the diagnosis.  Once the condition is given a name, the name, rather than the patient, is treated.  Treatment follows the cookie-cutter principle where “one size fits all”.  While a lack of brain stimulation may be the cause of the disorder, the allopathic approach only looks at the biochemical theory, and consequently uses medications to affect the brain’s dopamine levels.

            There are many different subtypes of ADD/ADHD, different severities of the condition, other co-morbid conditions and functional deficits; each person has their own individual causative mechanism(s), therefore, treatment also has to be geared to each individual.  The care that benefits one patient may be of no use to another.

            Chiropractors enhance the body’s natural self-healing capacity by removing interference in the nervous system.  The Chiropractic approach works to improve function, not just the symptoms as in medical neurology.  Often there is no healing until the subluxation is corrected, though sometimes subluxation correction alone is not enough.  [Schetchikova 2002a; Schetchikova 2002b]  While there is a lot of anecdotal evidence for the efficacy of Chiropractic care in ADD/ADHD, other than case studies, it is very difficult to find much that has been published.

            Case study one is from Carol Phillips D.C. at Northwestern College of Chiropractic.  A ten year old male entered the clinic on October 30, 1990 with a chronic history of ADHD and a history of ear infections (2 bilateral tympanostomies done), allergies (dust, mold, animal hair), and headaches (several times weekly).  He was delivered with forceps after 20 hours of labor.  For several days after delivery, it was noted that his head was cone-shaped.  He cried for over three months after delivery with apparent colic.  Diagnosed with ADHD at age seven, his parents started Chiropractic care for their son rather than giving him stimulant medication.  The parents reported great improvement with the ear infections, allergy attack, and headaches, but litter change in the ADHD symptoms.  The child continued to have difficulty concentrating, finishing projects, talking excessively in school, and felt driven to constantly move his body.  After three years, he was brought to Northwestern where he was given diversified spinal adjustments along with Upledger’s craniosacral therapy once a week for two months, twice monthly for three months and then once monthly thereafter.  The family report improvement in his symptoms at the end of four visits, with even greater improvement of the ADHD symptoms by the seventh visit.  By the eleventh visit, he no longer had any ADHD symptoms at home or in school.  At the eighteenth visit, the boy had a traumatic fall on his bike.  Within two weeks, there was an increase in his allergic reactions and within six weeks all of the ADHD symptoms had returned along with severe allergies and headaches.  He was again treated with cranial/spinal adjustive therapy and all of his symptoms had resolved with one month.  [Phillips 1991]

            Christine Anderson and Joan Partridge D.C. provided the second case study from Kentuckiana Children’s Center in Louisville, Kentucky.  A six year old boy was brought to Kentuckiana in March 1991 with complaints of “blanking” spells, behavioral problems, and an uncontrollable violent temper.  He had already been diagnosed as having severe ADHD, Oppositional Defiant Disorder, Family Dysfunction and Seizure Disorder.  Both his father and paternal grandmother also showed evidence of many ADHD symptoms.  Forceps were used during a difficult delivery.  As an extremely active toddler, he was aggressive, fast moving, bit people, had numerous falls (stitches to the forehead once and a lacerated tongue three times), and averaged two to three ear infections yearly.  After receiving a DT vaccination at age three, he had his first seizure which progressed to regular petit mal and post temporal seizures.  An October 1989 EEG displayed abnormal left central spike discharges.  Allergies were noted to dust, grass, and ragweed.  Psychotropic medications were tried, but the child’s mother said that they put her son into a drugged stupor, one made him shake all over; another made him lose his fingernails.  Other side effects included turning blue and bad personality changes”.  Radiographs showed a hyperlordotic cervical spine, and the staff found more than the average number of spinal subluxations.  Chiropractic adjustments were performed three times weekly for the first eighteen months, and were then reduced to every other week.  Seizures ceased after about one year of care, but resumed after the patient fell from a tree and broke his elbow.  His mother emphatically states that he always has a very good day at school following an adjustment and that his uncontrollable violent temper has been vastly improved.  [Anderson and Partridge, 1993]

            The third case study is from Tracy Barnes D.C. at Kentuckiana Children’s Center.  An eleven year old male was brought to Kentuckiana in June 1991 with complaints of a short attention span and an impulsive temper.  His former teachers said he had low motivation, impulsive actions, a strong desire to have his own way, difficulty focusing, and was easily distracted, even though he had an IQ in the superior range.  Ritalin was prescribed, but his mother saw no improvements in his behavior while he was taking it.  His history showed frequent ear infections that were treated with antibiotics; allergies to eggs, wheat, corn, soy, milk, chocolate, dust mites, dog hair, mold, grass, and ragweed.  He also suffered from recurring headaches, bedwetting, nose bleeds, and a persistent TMJ problem.   Radiographs showed a decreased cervical curve and atlas rotation.  Chiropractic care was begun twice weekly, and later reduced to once per week, using manual and activator methods.  Progress was sometimes erratic, but after three years, his teachers report that he now acknowledges responsibility for his actions, and has an improved attention span and improved temper control.  The TMJ is no longer a consistent problem, the bedwetting is resolved, and he has only occasional headaches while upper cervical care continues.  [Barnes 1995]

            Lasca Hospers Ph.D., D.C. of Life College in Marietta, Georgia, wrote five case histories of which two were diagnosed as having ADHD.  She used pre- and post-EEG or CEEG (computerized electroencephalography aka brain mapping) to demonstrate the changes made with Chiropractic care.

1. A fifteen year old male had been under the care of an upper cervical practitioner.  In June 1986, his parents wanted the objective evidence of an EEG to convince school administrators that their son improved while under Chiropractic care.  During gestation, his mother was diabetic.  The patient had problems with food allergies, doing better on a low sugar diet.  He had a history of several head injuries, one of which required 43 stitches.  Psychological testing showed deficits in his “left brain” tasks of verbal memory and meaning, math, and hand tasks that required synchronization of both hemispheres.  Medication was of no help.  There was a lack of synchronization of alpha and theta frequencies between the brain’s spheres shown on EEG.  Immediately after a Chiropractic adjustment, there was a five second long burst of synchronous alpha waves, which continued with a higher ratio of synchronous to asynchronous recordings with clear beta frequencies between the alpha segments.  While his handwriting did not improve, he was able to write more rapidly with less hesitation.  He was able to focus on the technical conversation between his father and the laboratory personnel regarding his EEG, and his social communication with them increased.

2. A 29 year old male with a history of being hyperactive as a child volunteered for the research study in November 1990.  He wanted to see if a chronic sacroiliac subluxation might have an effect on cortical brain function by optimizing the craniosacral pump.  His chief complaints were frontal headaches and nervousness that interfered with his studies in Chiropractic college.  The initial CEEG displayed higher beta and theta along with lower alpha frequencies.  He was adjusted SOT Category II for a right ASEX ilium for this study.  The CEEG displayed increased alpha and decreased beta, theta, and delta frequencies ten minutes after this adjustment, which still persisted after sixty minutes.  [Hospers 1992]

            Cheryl Langley D.C. of Marietta, Georgia published the next case study.  An eight year old female was seen starting in 1993 with a history of epilepsy that started eleven hours after birth, a heart murmur, hypoglycemia, bedwetting and ADD.  She was having 10 to 12 seizures daily, wetting her bed every night, had frequent mood swings, frequent stomach pains and diarrhea, and was in special educational classes for the learning disabled.  A cesarean section had been performed five hours after the patient’s head became stuck in the birth canal resulting in a fractured pelvis in her mother.  Her parents were told that she would never ride a bike or do the things normal children do and one doctor recommended that she be put in an institution.  Chiropractic adjustments were begun at three times weekly.  Within two weeks, the bedwetting decreased, at six months it was totally resolved.  At that time, she was also able to leave the special education classes and begin regular fifth grade classes.  After one year of Chiropractic care, the seizures were reduced from 10 per day to 8 to 10 per week, of a mild nature.  She continued to have checkups twice monthly.  [Langley 1994]       A seven year old male displayed an uncharacteristic memory loss, inability to concentrate, and general agitation after being involved in an automobile accident.  The patient also suffered from headaches, neck pain, bilateral leg pain, ear pain, hearing loss, loss of appetite, difficulty chewing, and difficulty breathing through the nose.  His medical doctor diagnosed ADD and he was started on Ritalin with a slight improvement in behavior.  After four months, his mother took him to Joseph Arme, D.C., who found an anterolisthesis of C2 on C3 and a cervical kyphosis from C1 to C4.  Thompson technique was used on a terminal point table for three times a week for the first sixteen weeks. At twelve weeks, the cervical curve was restored with a residual C2 anterolisthesis.  At seventeen weeks, the boy was taken off of Ritalin as the ADHD and other symptoms appeared to be resolved.  After the accident case was settled, the child’s mother discontinued his Chiropractic care.  The patient’s behavioral symptoms gradually returned and he was put back on Ritalin.  [Arme, 1993]

            A seven year old boy began care with Larry Webster, D.C. in February 1994.  He had hyperactivity, stuttering, retarded growth, a left leg approximately 1 inch short causing a limp when walking, and he was a slow learner.  The medical plan was to break the left leg and insert metal rods to equalize the leg lengths.  The Chiropractic exam showed an AIL-sacrum, L5 body left, and ASL atlas.  Initial care was scheduled for three times weekly for the first two months.  The leg discrepancy decreased each visit until they were balanced by the eighth visit.  Other notable changes by the eighth visit were:  the stuttering had stopped, school grades had risen from non-satisfactory to satisfactory, the hyperactivity had subsided, and the limp was no longer constant.  [Webster, 1994]

            The next case study is from Jennifer Brandon Peet D.C. of Shelburne, Vermont.  An eight year old male started Chiropractic care after three years of medication and behavior modification.  He was adjusted over a four month period using the Chiropractic Biophysics analysis and adjusting procedure.  All medications were discontinued after three weeks of care, and at six weeks he showed improvements in cognitive skills, ability to concentrate on a task, ability to control emotions, decreased aggressiveness, and dramatically improved math skills.  He continued to show marked improvements during his four months of care.  [Peet 1997]

            One of the earliest published group case studies was done by Dr. E. V. Walton in 1975.  Twenty-four learning impaired students were studied with half receiving Chiropractic care, compared to the other half who received either medication or no treatment at all.  Seven of the case studies follow.

1. A high school student with a history of failure, low morale, discipline problems, poor coordination, and a long history of clinical and medical treatment, was failing in three subjects.  After beginning Chiropractic care, he became highly motivated, was passing all his subjects, showed improved coordination, was able to participate in sports, and dropped all medications.
2. A non-motivated, negative, passive, nonverbal high school student on Ritalin and Dilantin was failing her classes.  After having Chiropractic adjustments, she was taken off Ritalin, began talking and expressing herself, and improved in reading speed and comprehension.
3. An extremely hyperkinetic and irritable eight year old had severe behavioral problems at home and school, with marginal to failing grades.  His Ritalin dosage had been increased from 5 mg/day to 70 mg/day with progressively diminishing results.  At the end of his Chiropractic care, he was entirely off the Ritalin, and his coordination improved so that he was able to participate in Little League baseball.  His behavior at home and school became exemplary, his attitude was excellent, and grades were up an average of one letter grade.
4. A nervous, underweight, elementary student suffering from insomnia had a four year history of marginally passing his classes.  His brief trial with medication caused poor emotional control and frequent weeping spells.  Chiropractic care provided a marked reduction in nervousness and greatly improved emotional stability.
5. Initially on heavy dosages of medication, this non-motivated high school student had a long history of medical treatment.  She was emotionally withdrawn, failing most of her classes, and marginal in the rest.  After four months of Chiropractic adjustments, she discontinued all medication, her self-confidence improved, and she was passing all her classes.
6. Hyperkinetic from birth and suspected of having neurological problems, this junior high school student had a traumatic early developmental history.  He was marginally passing only two classes, even though he had above average intelligence.  Making little to no effort in school, he was becoming a discipline problem.  Fine and gross motor control were significantly improved with Chiropractic care.  Becoming interested in sports, he played in Little League with a team that placed third in the state.  Plans to hold him back in a lower grade were dropped when his effort and motivation showed dramatic improvement.  After a summer remedial program, his academic progress was reported as excellent.
7. Variously diagnosed as minimally brain damaged, retarded, and/or suffering from a neurological dysfunction, this elementary student also suffered with severe emotional problems.  He displayed an impressive improvement in self-confidence after beginning Chiropractic care, even taking part in public speaking at school.  Other than some deficiencies in reading, his mental ability tests now indicated that he was normal for his grade level.  [Walton, 1975]

            In Australia, a comparison was made between 12 ADHD students on stimulant medication and 12 ADHD students receiving Chiropractic care.  The Chiropractic group showed decreased hyperactivity, increased attentiveness, and improved gross and fine motor coordination.  The group taking medication initially displayed decreased hyperactivity and increased attentiveness with no changes in gross and fine motor coordination.  Soon the effectiveness of the medication decreased, requiring an increased dosage to maintain the initial improvements.  (See Effects of Ritalin and Other Stimulants on the Nervous System above.)  Better than 50 percent of the medicated group experienced side effects such as personality changes, appetite loss, and insomnia.  The researchers concluded that Chiropractic care was 20 to 40 percent more effective than medication for the symptoms of ADD/ADHD.  [Brzozowske and Walton, 1980]

            A twelve month study was begun in October 1997 with 21 children diagnosed with ADD/ADHD.  They ranged in age from six to sixteen, seventeen were male and four were female, eight were on Ritalin.  In March 1998, thirteen of the children were still participating in the study, of which five were still on Ritalin.  Four of the case studies were highlighted:

1. A ten year old female needed parental supervision to complete homework due to lack of focus.  With three months of care she received “Most Improved Student” award by bringing her grades from a D and an F to a B and an A.
2. A 13 year old male was born with the umbilical cord wrapped around his neck and did not crawl as a baby.  With four months of care, his grades improved from four F’s to a B, a D, and notable improvement in the other two classes.
3. A twelve year old male had been run over by a car at age 5 while riding his skateboard.  In school, he displayed severe discipline problems resulting in several suspensions and failing grades in all his classes.  With care, his grades improved to a B, three C’s, and two D’s, though there was little improvement noted in his behavior.
4. A fifteen year old male had allergies and severe hand tremors.  The tremors diminished within one week of care.  His grades improved to three A’s, two B’s, and a C with five months of care.  [Wendel, 1998]

            Finally, the only report published in a peer reviewed journal is by Giesen, Center, and Leach.  Seven children between the ages of seven and thirteen that had been diagnosed with ADHD were selected for this study.  The children were taken off of stimulant medication for the summer, and the study began after a two week “wash out” period.  During a minimum two week baseline period of data collection, the children received placebo Chiropractic treatment.  The children were seen three times per week, and the Chiropractor and scientists were blinded from each other’s data collection.  Four of the seven showed improvement in their Chiropractic radiographic findings, five of the seven showed a reduction in overt behavioral activity, four showed improved autonomic activity levels, and four showed improvement in parental ratings of hyperactivity.  Five of the seven showed improvements in at least three of the four outcome measures, in spite of the study being four weeks or less of Chiropractic care.  The study had to be completed before the students returned to school at the end of summer.  [Giesen et al. 1989]

            The most common theme seen in these studies is that many of these children had a history of allergies, ear infections, headaches, and bedwetting along with their ADD/ADHD symptoms.  Many had significant improvements in all of these symptoms with Chiropractic care.  The Chiropractic care most often involved some form of upper cervical adjusting, no matter which technique or system of analysis was used.  Chiropractic has a substantial anecdotal success in caring for ADD/ADHD.  What we lack is the hard core research to back this up.

            This lack of research may soon be changing.  Julie Bjornson, D.C., Robert Melillo, D.C., and Mark S. Smith, D.C., all Diplomates of the American Board of Chiropractic Neurologists were recently interviewed by Nataliya Schetchikova for the Journal of the American Chiropractic Association.  They discussed the importance of Chiropractic in the care of ADD/ADHD, and the theories behind how Chiropractic helps the condition.  The brain is not a static entity whose function is genetically determined.  It continues to grow:  adapting to new stimuli, changing, learning.  Stimulating the brain will cause plastic changes.  Developmental delays can be resolved by discovering what stimuli are required to correct deficient functions in the brain.  [Schetchikova 2002b]

            This philosophy is the very foundation for the work of the Chiropractic neurologists, who work to heal their patients without the use of drugs and surgery.  The hypo-functioning part of the brain is identified so that different sensory stimuli can be used to promote brain growth and normalize brain function in the deficient hemisphere. 

            Ability to focus attention, visual-spatial orientation, reading comprehension, and non-verbal social communication are right-brain responsibilities.  The left brain regulates verbal communication.  When testing shows a decreased function in one side of the brain, it can be stimulated with light, sound, heat, cold, somatosensory stimulation, vibration, exercise, or spinal and/or cranial adjusting.  The right brain responds to low frequencies of light and sound, while the left brain responds to higher frequency stimulation.  Children with planning, organization, and coordination problems benefit from timing therapies.  The hand or foot on the side of the deficient hemisphere can clap or tap to the beat of a metronome.  Other exercises may involve spinning, balancing, visual-motor exercises (e.g. throwing darts at a target) and cognitive tasks (e.g. crossword puzzles and mazes).

            Wyatt’s test is used to evaluate reading comprehension, math, vocabulary, and reasoning.  This is given before care begins, and then every three months to evaluate progress.  With this program, most children achieve a dramatic two-grade-level increase in their abilities.  Because this program changes the brain’s function, these results are maintained and built upon.  When children are medicated with psychostimulants, some may have short term scholastic improvements.  The problems return as soon as they stop the medication, because the underlying problem has not been addressed.  [Schetchikova 2002a]

NUTRITIONAL SUPPORT

            While proper nerve function is being re-established by reducing the vertebral subluxation complex, proper nutrition is also needed to repair and rebuild the nervous system in the ADD/ADHD sufferer.  Following are some of the key nutrients that are currently known and their rationale in the healing process.

Amino Acids:  these are the essential building blocks of the neurotransmitters

• DL-Phenylalanine:  very stimulating, helps to improve attention  [Blum 2000, 67]
• L-Tyrosine:  converts to L-Dopamine, norepinephrine, and epinephrine; also useful for depression, anxiety, hypertension, and smoking withdrawal symptoms  [Bell and Peiper 1997, 63; Sahley 1988, 23]
• L-Glutamine:  energy source for brain, increases concentration and alertness, improves memory retention and recall, reduces sugar cravings [Bell and Peiper 1997, 63], helps control alcoholism, schizophrenia.  [Sahley 1988, 30-32]
• L-Tryptophan:  precursor to the inhibitory neurotransmitter serotonin, controls moods [Sahley 1988, 19-20], can replace Ritalin and Cylert [American College of Nutrition 1987], currently under ban by the FDA
• L-5-Hydroxytryptophan (5-HTP):  substitute for L-Tryptophan, should only use 1/20th to 1/10th of mg dosage compared to L-Tryptophan
• Gamma-aminobutyric acid (GABA):  precursor to most important inhibitory neurotransmitter in brain [Sahley 1988; 18-19, 22-23], anti-anxiety agent and mild tranquilizer [Bell and Peiper 1997, 63], can mimic tranquilizing effect of Valium and Librium without heavy sedated effect [Sahley 1988, 20-22; Shaw and Pearson 1982]
• Taurine:  precursor to inhibitory neurotransmitter [Sahley 1988, 18-19], offers greatest relaxation with sedation while having no effect on the brain’s alpha wave activity [Blum 2000, 67], reduces excessive movement in hyperactivity [Bell and Peiper 1997, 63], second most important inhibitory neurotransmitter in brain  [Sahley 1988, 22-23]
• Glycine:  precursor to third most important inhibitory neurotransmitter [Sahley 1988, 18-19], reduces aggression and manic-depression [Sahley 1988, 23-24], promotes sleep  [Blum 2000, 67]
• L-methionine:  natural antidepressant [Blum 2000, 67]
• L-Leucine:  daytime anti-anxiety agent [Blum 2000, 67]

Essential Fatty Acids:  often significantly reduced in ADD/ADHD [Burgess et al. 2000; Stevens et al. 1995]; co-existing allergies, eczema, and asthma often relieved

• docosahexaenoic acid (DHA):  precursor for building cell membranes in eyes, brain, nervous system  [Zimmerman 1999, 73-74]
• dihomo-gamma-linolenic acid (DGLA):  precursor for building cell membranes in eyes, brain, nervous system  [Zimmerman 1999, 73-74]
• arachidonic acid (AA):  precursor for building cell membranes in eyes, brain, nervous system  [Zimmerman 1999, 73-74]

Minerals:

• Magnesium:  calms central nervous system, activates enzymes to metabolize carbohydrates and amino acids; helps utilize vitamin B complex, vitamin C, and vitamin E; helps with apprehensiveness, nervous irritability, muscle twitches, tremors, noise sensitivity, confusion, and disorientation.  [Sahley 1988, 24]

• Calcium:  may help with sleep disturbances, inattentiveness, irritable feelings, and anger  [Sahley 1988, 24-25]
• Zinc:  controls protein synthesis, wound healing, carbohydrate digestion; deficiency involved with fatigue, susceptibility to infection, decreased appetite, alertness, loss of taste  [Sahley 1988, 25]

Vitamins:

• Vitamin B complex:  first signs of deficiency are symptoms such as fear, anxiety, depression, mood swings, temper tantrums, inability to concentrate, withdrawal, listlessness, sleep disturbances, headaches, and fatigue  [Sahley 1988, 26-27]
• Niacinamide (B3):  has quieting effect on nervous system, especially on distraction  [Sahley 1988, 27]
• Pantothenic Acid (B5):  helps with stress, anxiety, depression, allergies  [Sahley 1988, 28]
• Pyridoxine (B6):  cofactor for transamination of amino acids, useful with tryptophan to correct aggression, calms nervous system [Sahley 1988; 19-20, 28]
• Vitamin C:  essential to normal function of cells
• Vitamin E:  essential to normal function of cells, useful in attention deficit disorder and both aggressive and passive hyperactivity, helps learning process  [Sahley 1988, 29-30]

Dr. Jay Holder’s most recent protocol (2001) for ADD/ADHD natural supplementation is as follows:

• L-phenylalinine 750 mg/daily
• D-phenylalinine 750 mg/daily
• L-glutamine 750 mg/daily
• L-tyrosine 750 mg/daily
• L-Tryptophan 500 mg/daily if available, questionable if 5-HTP can be substituted but should only use 50 mg/daily as replacement
• A generic multi-vitamin, multi-mineral supplement  [Holder 2001]

            Dr. Daniel Amen’s ADD/ADHD protocol of natural supplements (2001) for the six types of ADD is as follows:

TYPE 1 and TYPE 2 ADD

• L-tyrosine 500-1500 mg/2-3 times daily
• Grape-seed extract
• Pycnogenol

TYPE 3

• L-tryptophan 1000-3000 mg at bedtime (can substitute 5-HTP 50-300 mg/day)
• L-tyrosine (may increase overfocused symptoms if taken alone) 500 mg/2-3 times daily
• St. John’s wort (Best with L-tyrosine) 600 mg/morning, 300 mg/night (up to 1800 mg/day)
• Inositol 12-20 mg daily

TYPE 4

• Gama-aminobutyric acid (GABA) 100-500 mg/day
• Vitamin E 400-600 IU/twice daily
• Phosphatidyl serine  100 mg/3 times daily
• Ginkgo biloba 60-120 mg/twice daily
• May need to use anticonvulsants

TYPE 5

• DL-phenylalanine (DLPA)    (do not use with PKU [phenylketonuria]) 400 mg/3 times daily on empty stomach
• S-Adenosyl-Methionine (SAMe) (do not use with bipolar disorder or Type 6 ADD) 200-400 mg/ 2-4 times daily

TYPE 6

• GABA 100-500 mg/day
• Fish oil or flaxseed oil 1 tablespoon daily
• May need to use anticonvulsants
• Symptoms worsen with St. John’s wort  [Amen 2001; 101-103, 141, 143, 145, 232, 248-249,251, 255-263]

ADD/ADHD—A DIFFERENT PERSPECTIVE

            ADD/ADHD is usually thought of as a disability or dysfunction in the brain.  But suppose it is an adaptation for survival in nature.  Thom Hartmann's Complete Guide to ADHD, Help for Your Family at Home, School and Work points out that while the neurologically mediated behaviors seen in ADD/ADHD may not be useful in most of modern society, these same behaviors would be ideally suited for survival as a hunter in a primitive environment.  As he explains:

1.      They live totally in the moment, not considering any other place or time, past or future when chasing their prey.  When in the hunt, time speeds along; when not in the hunt, time moves very slowly.

2.      They are flexible, able to change strategy instantly.  Orderliness is not especially important to them.  If they lose their prey and another one appears, they can change direction immediately.

3.      While not having a lot of staying power, they can have incredible bursts of energy when needed.

4.      They are visual thinkers, describing their actions in terms of pictures rather than words and feelings.  Not much for strategic planning, they act rather impulsively, going straight for the kill.

5.      The hunt is what they live for, while being totally bored by the tedious tasks in life.  After the kill, someone else can clean the fish, dress the meat, or fill out the paperwork.

6.      They are willing to face the danger that others avoid.  A wounded animal can kill you, but the hunter takes the risk.  (What do you call a really poor hunter?  A vegetarian!)

7.      They are hard on both themselves and those around them.  Frustration, toleration, and impatience thresholds are very low when your life is on the line with split-second decisions.

When the classic ADD/ADHD symptoms are compared to the characteristics of a very successful hunter, they are nearly identical.  The ADD/ADHD individual would make an extraordinarily good hunter, while failure to possess any one of these characteristics could be fatal in a savage, unforgiving world.  [Hartmann 2000, 21-25]

            To again quote Thom Hartmann:

            In India there appears to be a very different view of ADD than what is conventional in the United States.  During the monsoon season of 1993, the week of the Hyderabad earthquake, I took a 12-hour train ride halfway across the subcontinent to visit an obscure town near the Bay of Bengal.  In the train compartment with me were two Indian businessman and a physician, and we had plenty of time to talk as the countryside flew by from sunrise to sunset.

            Curious about how they viewed ADD, I said, "Are you familiar with the personality type where people seem to create stimulation but have a hard time staying with any one thing?  They hop from career to career, and sometimes even from relationship to relationship, and never seem to settle down to one thing?"

            "Ah, we know this type well," one of the men said, the other two nodding in agreement.

            "What do you call it?"  I asked.

            "Very holy," he said.  "These are old souls, near the end of their karmic cycle."  Again the other two nodded agreement, perhaps a bit more vigorously in response to my startled look.

            "Old souls?"  I said, thinking that a very odd description for what we call a disorder.

            "Yes," the physician said, taking his turn in the conversation.  "In our religion, we believe that the purpose of reincarnation is to eventually free oneself from worldly entanglement and desire.  In each lifetime we experience certain lessons, until finally we are free of this earth and can merge into the oneness of what you would call God.  When a soul is very close to the end of those thousands of incarnations as, he must take a few lifetimes and do many, many things, to clean up the little threads left over from his previous lifetimes."

            "This is a man very close to becoming enlightened," the first businessman added.  "We have great respect for such individuals, although their lives may be difficult."

            The other businessman raised a finger and interjected: "But it is the difficulties of such lives that purify a soul."  The others nodded agreement.

            "In America we consider this a psychiatric disorder," I said.  All three look startled, then laughed.

            "In America, you consider our most holy men, our yogis and swamis, to be crazy people, too," said the physician with a touch of sadness in his voice.  "So it is with different cultures.  We live in different worlds."  [Hartmann 2000, 78-79]

            The difficulty comes when attempting to fit the ADD/ADHD characteristics into modern society.  Their impulsivity does not allow them to sit still for very long.  Their minds are always racing.  They have a tendency to create justifications for their behaviors that are not in line with society’s rules.  Quite often, those with ADHD are very intelligent people, but they misapply their efforts.  Their constant craving for excitement leads them into fast-paced activities or risky behaviors.  Many turn to one or more of the addictive behaviors in their attempt to achieve a sense of well-being, if only temporarily. 

            Occasionally, there is the rare individual who does find a way to cope with the monotony of the world.  If they have supporting people to keep them organized and focused, they can become the “movers and shakers” in the world.  Moving from one creative project to another, they can be the idea people, while their staff carries out the tedious, boring, mundane details.  Often, they need to be doing several things at one time, just to get anything done at all.  They tend to gravitate to occupations that are fast-paced and exciting such as car racing, emergency room personnel, or fighter pilot.

            Those with ADD/ADHD tend to be insatiable; there is never enough of anything in life.  Whether it is accumulating wealth, possessions, or knowledge, they are never content with what they achieve.  The quest for more gives them excitement, but they always need more to feel good about themselves.  Their happiness is always in the future:  “I’ll be happy when…” or “I’d really be happy if only…”.  Their satisfaction is only fleeting, and eventually this striving becomes an addiction.  The ADD/ADHD person is compelled to have more and more just to achieve the same sense of well-being.

CONCLUSIONS

1) Many cases of obsessive/compulsive and addictive behaviors along with ADD/ADHD are caused by a lack of dopamine D2 receptors,

2) Often this is because of a genetic variation of the A1 allele of the dopamine DRD2 receptor gene,

3) This can also result from using mind-altering addictive drugs or alcohol,

4) This can also result from using other over-the-counter and prescription drugs and medications, man-made hormones, vaccinations and inoculations, or toxic chemicals and pollutants,

5) This can also result from mind-altering experiences and excessive stress,

6) Innate Intelligence working through Educated Brain will find a way to compensate for the lack of feelings of well-being due to the lack of dopamine receptors,

7) Subluxation based Chiropractic along with the proper amino acid supplementation has been highly effective in the care for many of these disorders.

            The Chiropractor of the future will know exactly how to adjust to produce happiness at once instead of sorrow.  “Blues” are not caused from trouble, real or imaginary, but from a diseased condition which can and will be relieved instantaneously by the Chiropractor of the future.  Find out how and where (to adjust).—Howard Nutting as quoted by B. J. Palmer, D.C., Ph.C.  [Palmer 1951, 132]

            The science of Chiropractic has given us the cause of disease, a knowledge for which humanity has been hungering since the dawn of civilization.  It will, in time, do much to relieve poverty and crime, for they are largely diseased conditions.  [Chiropractic] will in time empty our jails and penitentiaries.  [Palmer 1910, 558]

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