Course Description:

$375

This six-module course, co-taught by Dr. James Greenblatt and Dr. Arwen Podesta, elucidates a comprehensive functional medicine approach to the treatment of substance use disorders, targeting reward-pathway dysregulation and the many nutritional deficiencies associated with addiction that can alter brain function.  Integrating mainstream approaches such as MAT and psychotherapy with evidence-based functional approaches such as nutrient therapy, acupuncture, and mindfulness, this course provides clinicians with a roadmap for navigating addiction disorders and bringing patients into balance.

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Modules:

1. Module 1 (Podesta)

  1. Understanding Addiction
    1. Diagnostic classifications, criteria
    2. Statistics and epidemiology, general
    3. Statistics and epidemiology, opioid crisis
  2. How Did We Get Here? A Brief History of Substance Abuse
    1. Substance use from Ancient Sumer to the 21st Century
    2. Sources of nonmedically used prescription opioids
    3. Strategies for slowing the opioid use epidemic

1. Module 2 (Podesta)

  1. The Neurobiology of Addiction
    1. Biology, stress, and substances: influences on risk
    2. Reward Deficiency Syndrome
    3. Genetic and epigenetic influences
      1. Opioids
      2. Stimulants
  2. Current Treatment Models
    1. An overview of existing modalities
    2. Medication-Assisted Treatment / Recovery (MAT/MAR)
      1. Medications for Alcohol Addition
      2. Medications for Stimulant Addiction
      3. Medications for Nicotine Addiction
      4. Medications for Opioid Addiction
      5. Maintenance Medications: Relaps Prevention
    3. Where We Go from Here

1. Module 3 (Podesta)

  1. Stigma: Language Matters
    1. Policy and Public Education
    2. Rethinking How We Talk and Write About Addiction: Do’s and Don’ts
  2. Completing the Model: Traditional and Evidence-Based Nontraditional Treatments
    1. Acupuncture, NADA ear acupuncture
    2. Genetic addiction risk score (GARS)
    3. Nutrition
      1. Influences on Methylation
      2. MTHFR polymorphisms, implications for presentation, treatment
    4. Nicotinamide Adenosine Dinucleotide (NAD)
    5. Mindfulness
    6. Novel Frontiers in Integrative and Complementary Therapies
      1. reSETTM
      2. Hyperbaric oxygen
      3. Equine Therapy
      4. TMS
      5. Ketamine

1. Module 4 (Podesta)

  1. Low Dopamine Tone and Addiction
  2. Detox Needs
  3. Honing the Functional Clinical Interview
  4. A Closer Look: Opioids 
    1. SNPs linked to reward deficiency pathways
    2. Treatment overview
  5. Treatment Overview: Benzodiazepines, Alcohol
  6. Treatment Overview: MDMA and similar drugs
  7. Treatment Overview: Cocaine, Amphetamines
  8. Clinical Pearls for the Treatment of Low Dopamine Tone
  9. Adaptogens for Environmental Stress, Trauma 

1. Module 5 (Greenblatt)

  1. Addiction: An Overview
  2. Bill. W’s Story: Recovery, AA, and Niacin Therapy
  3. Targeting nutrients and nutrient deficiencies  
    1. B Vitamins: Niacin (B3)
      1. Mechanisms, history of use for SUDs (Hoffer, Kaufman)
      2. Niacin and brain health
      3. Clinical pearls for supplementation
    2. B Vitamins: Pyridoxine (B6)
      1. Role in enzymatic function, neurotransmitter synthesis pathways
      2. Pyroluria
      3. Symptoms, testing, functional treatment
    3. B Vitamins: B12
      1. How B12 affects mood: role in 1-carbon metabolism
      2. Symptoms of B12 deficiency: somatic, neurologic, behavioral
      3. Alcoholism and B12 depletion
      4. Blood levels: elucidating “normal”
      5. Testing: clinical pearls
    4. B Vitamins: B9 (Folate)
      1. Forms of B9
      2. Deficiency risk factors + mechanisms
        1. MTHFR mutation
        2. Alcohol abuse
        3. Methylation: implications, links to addiction
  4. Pathophysiology of Nutrient Deficiencies in Alcoholism
    1. Neurologic sequelae
  5. Illuminating a New Model: Functional Psychiatry

1. Module 6 (Greenblatt)

  1. Rethinking the genes / environment equation: [G x E = L]
  2. Celiac Disease
    1. Pathophysiology, presentations
    2. Celiac psychosis
    3. Gliadorphin: toxic opioid neuropeptide
    4. Gluten, morphine variable response, and pain
    5. A gluten-free diet may not be enough!
  3. Amino Acids
    1. Role as enzyme, neurotransmitter precursors
    2. Amino acid depletion: digestive dysfunction
      1. Hydrochloric acid
      2. Zinc deficiency
    3. Amino acids, neurotransmitters, behavior, and addiction
      1. Tryptophan
      2. Phenylalanine
      3. Glutamine
  4. Amino Acid Infusion Therapy
    1. The Dopamine Depletion Hypothesis of addiction
    2. The brain-reward cascade
    3. Goals of Neuroadaptogen Amino Acid Therapy (NAAT)®
    4. Review of research evidence
  5. Laboratory Testing to Assess Amino Acid Status
  6. Zinc, Digestion, and Amino Acids
    1. Zinc function in the digestive cascade
    2. Common causes of zinc depletion, deficiency
    3. Implications of copper and zinc antagonism
  7. Fats and Cholesterol
    1. Cholesterol
      1. Role in neuronal health
      2. Implications and ramifications of low cholesterol: research and clinical evidence
    2. Essential Fatty Acids
      1. Role in neuronal health, neurotransmitter signaling, membrane integrity/fluidity
      2. Omega-3s and addiction: mechanisms
      3. Essential fatty acids in addiction treatment
      4. Recommendations and considerations for supplementation

1. Module 7 (Greenblatt)

  1. N-Acetyl Cysteine (NAC)
    1. Role in endogenous antioxidant pathways
    2. As a treatment for alcohol addiction
    3. As a treatment for cocaine addiction
    4. As a treatment for body-focused repetitive behaviors (BFRBs)
  2. The Gut-Brain Axis, Dysbiosis, and SUDs
    1. Overview of the gut-brain axis (GBA)
    2. Dysbiosis in SUDs
    3. Neurocognitive and behavioral sequelae of dysbiosis, reduced microbial diversity
    4. Organic Acids Testing to detect neurotoxic Clostridia metabolites
      1. Treatment protocol to address elevated HPHPA
  3. Lithium in the Treatment of SUDs
    1. An overview of lithium, a natural, essential mineral
    2. Neuroprotective mechanisms and effects of lithium
    3. Lithium for SUDs
      1. Alcohol
      2. Amphetamines
      3. Cocaine
      4. Behavioral addictions
      5. Cannabis withdrawal
    4. Elucidating dose: nutritional vs. pharmaceutical lithium
      1. What is a maintenance dose?  What level is indicative of deficiency?
    5. Testing: Hair analysis
    6. Formulations: orotate vs. carbonate
  4. Cannabidiol (CBD)
    1. Exploring CBD as an intervention for addiction
    2. The endogenous endocannabinoid system (endocannabinoidome)
      1. CB1, CB2 receptor distribution
      2. CB1 receptors and the AC/cAMP cascad
    3. The importance of EFA repletion
    4. The cannabis – cholesterol connection
    5. CBD and serotonin signaling
    6. CBD for SUDs: Exploring Evidence
      1. CBD for sleep
      2. CBD for addiction
      3. Heroin
      4. Alcohol
      5. Cannabis use
      6. Tobacco
    7. Is CBD safe?
  5. Coalescing a Functional Medicine Model for SUD Treatment