Anxiety & Depression
It is appropriate to first discuss research that suggests the spine may be an anatomical extension of the limbic system. The limbic system is the site where feelings are mediated. These feelings are expressed through the reward cascade model as first proposed by Blum and Kozlowski (1990). We now know many naturally occurring brain and spinal cord substances play a role in both emotions and pain reduction, leading to an increased sense of wellbeing. In this regard, Pert and Diensfrey (1988) and Lewis and colleagues (1981) suggested the limbic system should include not only the amygdala and hypothalamus, but also the dorsal horn of the spinal cord. In fact they point out that a number of neuropeptide receptors having psychophysiological effects can be found in the dorsal horn of the spinal cord. Burstein and Potrebic (1993) of the Department of Neuro-Biology at the Harvard Medical School provide evidence for direct projection of the spinal cord neurons to the amygdala and orbital cortex. Further, these authors suggest that these pathways play a role in neuronal circuits that enable somatosensory information, including pain, to effect autonomic, endocrine, and behavioral functions. Giesler, Katter & Dado (1994) found specific spinal pathways which project to the limbic system for nociceptive information, and these pathways seem to include the hypothalamus bilaterally. In unpublished work conducted prior to the previously mentioned network study, Holder and Blum decided to test the hypothesis that chiropractic care goes beyond its known role in musculoskeletal disorders. This is based on the speculation that via adjustment of the spine, a subluxation free spine would facilitate an enhanced sense of well-being via limbic activation of dopamine release at the nucleus accumbens. We therefore carried out preliminary studies at the Exodus Treatment Center in Miami, Florida, where we incorporated chiropractic procedures (Torque Release Technique) to see if we could significantly affect psychological states, drug withdrawal, and patient retention rates in inpatient SUD residents.
The investigation was a randomized clinical trial, blinded and with a placebo control to mimic the subluxation-based chiropractic treatment. The study included 98 human subjects and consisted of three groups: a standard residential treatment group, a standard residential treatment group plus chiropractic adjustments, and a standard residential treatment plus placebo chiropractic adjustments. The results analyzed reveal that chiropractic adjustments are producing a significantly improved retention rate within a 30 day residential model compared to both the placebo and the standard groups, with a statistically significant improvement in anxiety and depression scores (based on a battery of seven psychological inventories) when compared to sham controls, as well as a significant reduction in nursing station visits compared to controls. While these results are intriguing and open to a number of possible interpretations, the study needs to be replicated by an independent laboratory before any conclusions can be drawn.
This study relates association between chiropractic care and state of well-being. Dr. Holder chose addicts for the study population since addicts best represent those persons suffering from Reward Deficiency Syndrome (a lack of state of well-being) and its relationship to the Brain Reward Cascade. Therefore, the study was conducted at Exodus Addiction Treatment Center, a 350-bed Addiction hospital located in Miami, Florida. During the 18-month study, the patient population was divided into three test groups. Group One received standard addiction treatment including group therapy, psychotherapy and medical care. Group two received the same addiction treatment but was also provided subluxation-based chiropractic adjustments using the Torque Release Technique delivered via the use of the Integrator adjusting instrument. Group Three was the placebo group which received the same addiction treatment performed in Group One and two, but was also provided placebo chiropractic adjustments by modifying the Integrator to fire without any force or frequency characteristics.
Just 56 per cent of Group One finished their treatment program, compared with 75 per cent of Group Three (placebo group), but this was not statistically significant thereby failing to support that chiropractic had a placebo effect. However, 100 per cent of the patients in Group two receiving true chiropractic adjustments finished their treatment program. This 100 per cent Retention Rate has never been accomplished by any other modality including pharmaceutical, psychological or medical treatment. Retention Rate is the “gold standard” in the field of addiction treatment. It is the primary yardstick for funding treatment programs that government funding agencies and drug courts use to fund and/or refer patients to. There are now over 400 drug courts requiring treatment instead of incarceration throughout the United States. The Miami Drug Court was the first. In addition, Group two also made far fewer visits to the nurse’s station and showed statistically significant decreases in anxiety, a leading cause of relapse to addicts. Only nine per cent of those receiving adjustments by Torque Release Technique made one or more visits to the nurse’s station while in the program, compared to 56 per cent of the placebo group and 48 per cent of the usual care group, This suggests that the chiropractic adjustments not only lacked a placebo effect, but that the placebo group did the worst. This was quite important since our detractors like to blame chiropractic’s success on some sort of placebo effect; they certainly can’t in this case.
The Beck’s Depression Inventory revealed that chiropractic care got depression levels below a score of 5 in 4 weeks, something which usually took one year of medication and psychotherapy to achieve the same result. The Spielberger State Anxiety Test revealed that chiropractic care got anxiety levels below a score of 35 in 3 weeks. Normally it took six months of medication and psychotherapy to achieve the same result. The study clearly showed a strong association between chiropractic care and significant improvement in state of well-being and increased retention of patients in an addiction treatment program. Currently, retention is a major hurdle in treating addictions.
There are five addictions: chemical, work, eating disorders, sex and gambling. This includes but is not limited to the compulsive disorders such as ADHD, Tourette’s Syndrome, depression and anxiety disorders, Anecdotal Torque Release Technique research has revealed restoration of abnormal EEG brain wave activity in ADHD following subluxation correction. By error of omission, the leading cause of death in North America is drug-related and is the leading cause of crime at 84 per cent. Interestingly, there are three causes of subluxation: mental, chemical, physical. Addicts who finish a 30-day program have a much better chance of overcoming their addiction and staying clean. However, nationally, only 72 per cent of all participants manage to complete such a program. That’s why the 100 per cent retention rate offered by subluxation correction in this study is so important. Too many people who could be helped by these programs are dropping out too soon. If we can get them to stay in the program, we can begin to see real progress in our battle against addictions. Success can be attributed to a “major change in the anxiety levels, which went down much more dramatically in the chiropractic group. “In these kinds of treatment facilities, if you make an effort that’s successful to reduce anxiety, you can keep people around longer,” my colleague Dr. Robert Duncan added. The Torque Release Technique and the Integrator were created out of this study by accident. In designing the study Dr. Holder had to find a way to ensure consistency and reproducibility in the application of delivering the chiropractic adjustment and to measure its outcome. To accomplish this it was necessary to adjust by instrument rather than by hand. However, chiropractic had not yet developed an instrument that reproduced what the chiropractor’s hands were intended to do; and the most classical thrust maneuver by hand was Toggle Recoil.
CANADIAN CHIROPRACTOR The Magazine for Canada’s Chiropractic Profession OCTOBER 2001, VOLUME 6 NUMBER 5 26