Healing through the senses: aromatherapy in addiction treatment with women

¶ … Aromatherapy in Addiction Treatment for Women

Many people regard the sense of smell of the least valuable of the five senses; however, experts today point out that the human olfactory system provides more environmental information than any of the other senses. Furthermore, while there has long been a firmly held belief among alternative medicine practitioners that specific types of fragrances could trigger specific changes in emotional states, recent findings by the 2004 Nobel Prize winners for Physics appear to scientifically validate these claims. As a healing modality, though, most authorities today believe that aromatherapy is many thousands of years old, dating back to the times of the ancient Egyptians, Mesopotamia and ancient China (Ba, 2003). Today, aromatherapy represents a promising new addition to the traditional medicine for a wide range of conditions, including addiction in women. The goal of this paper is to support and validate my findings on the efficacy of aromatherapy used in substance abuse treatment programs for women who typically suffer from many symptoms related to early stages of recovery. The rationale for investigating the efficacy of aromatherapy relates to its potential to mediate the problems generally associated with substance abuse recovery such as sleep and mood disorders, anxiety and depression. To the extent that these associated conditions can be mediated is the extent to which this researcher believes the recovery process can be facilitated and the chances for success heightened.

Review and Discussion: Aromatherapy.

Definitions and Background. Although people have been using what is considered to be aromatherapy today for several millennia, the distillation of plant essences is credited to Islamic alchemists; however, aromatherapy as it is practiced today has a much more recent history. According to Ba (2003), in 1937, a French perfumery chemist by the name of Renee Gatefosse was the first to coin the term "aromatherapie" to describe the application of volatile oils to produce a therapeutic response to various conditions and diseases typically experienced by humans. While the term may be new, the practice is truly ancient, and Price, Price and Peno l (1999) note that, "Plants and their extracts have been used since time immemorial to relieve pain, aid healing, kill bacteria and thus revitalize and maintain good health" (p. 1). While the word itself was not coined until the last century, the distilled extracts from plants -- the essential oils -- have been used by humankind for countless years in religious rites, perfumery and hygiene. According to Ba, cedarwood oil is known to have been used by the Egyptians for embalming and for hygienic purposes 5,000 years ago; this oil is most likely the first "distilled" oil to have been produced (although the process used remains open to speculation). Further, both the lavender plant along with its essential oil were used by Hildegard of Bingen in the 12th century, and by the 15th century, it is believed that the essential oils of turpentine, cinnamon, frankincense, juniper, rose and sage were also known and used (Pignatelli, 1991). By the beginning of the 17th century, about 60 oils were known and used in perfumes and medicines (Price et al., 1999).

Surviving fragments of papyrus suggest that in the time of the pharaohs, the Egyptians considered the aroma of spices such as cinnamon as medicinal. Further, the traditional herbal medical practitioners of ancient Greece, Rome, India, and the Far East did not differentiate between medications and perfumes because both were believed to have medicinal properties. Other early societies recognized the therapeutic value of such preparations as well; traditional Chinese medicine recommended that brewed tea should be inhaled as well as ingested and fragrant medicinal baths are still widely used in Japan today. Similar yet different approaches were employed by other societies as well; for example, "forest therapy" in Germany involves inhaling eucalyptus and other arboreal vapors (Ornstein & Sobel, 1989). Despite these repeated instances of traditional medicines using the power of aroma to improve health, contemporary mainstream practitioners have frequently been skeptical concerning the efficacy of such alternative medicine approaches. Nevertheless, there is a growing body of scientific evidence that supports the use of many of these alternative medicines in many healthcare settings in the West today.

Overview of Olfactory System. The olfactory system in humans works by transmitting information on odorant molecules from the nose to the brain; these odorant-receptor interactions then trigger neurons to send signals to the olfactory bulb, a structure located in the front of the brain (Brownlee, Perkins & Goho, 2004). These authors note that the olfactory bulb then relays information about the odor to thought and emotion centers in the brain's (Brownlee et al., 2004).

The primary feature of the olfactory system that plays a role in aromatherapy is that the specific plants employed are considered to have particular therapeutic powers (Crowder & Schab, 1995). Some examples of the reputed benefits of certain flowers are for jasmine to be an antidepressant, lavender to be an anxiolytic, rosemary to sharpen memory, and water-violet to promote tranquility and grace (Crowder & Schab, 1995). Future studies may be able to further refine the current views concerning the notion that particular odors, like specific drugs, can have specific effects on mood and physiology. Today, researchers do know that conditioning of specific reactions is a major influence of smell; further, people tend to have very different associations with odors, and therefore different responses to them (Ornstein & Sobel, 1989). They also know that the olfactory system is "the oldest and most complex sensory system capable of conveying environmental information across long distances" (How Does Chemical Exposure Impact the Sense of Smell?, 2003, p. 24).

The recent award of the Nobel Prize for Physics to Richard Axel of Columbia University and Linda Buck of the Fred Hutchinson Cancer Center in Seattle for their work on olfactory genes supports the belief that specific types of aromas can trigger specific responses in humans. According to Brownlee et al., prior to the work by Axel and Buck, researchers knew little about the cellular and molecular mechanisms underlying olfactory system. The authors note that previous anatomical studies had shown that olfactory neurons project hair-like cilia into the nasal cavity; however, scientists had been unable to identify the specific olfactory receptors on these cilia or to understand precisely how they worked. In the past, the olfactory system had been largely ignored by sensory scientists who were more interested in understanding the mechanisms of the other senses, such as sight and hearing; the reasons for this focus were twofold: 1) The sense of smell is the most expendable of human senses and 2) there was a paucity of scientific tools available for investigating this aspect of the human senses (Brownlee et al., 2004). Innovations in a DNA-copying technology known as polymerase chain reaction, however, allowed the researchers to identify the sites that encode olfactory receptors in rats. Since 1991 paper, the researchers have discovered more than 1,000 olfactory receptors in rats; however, the number discovered to date in humans is only around 350 (Brownlee et al., 2004). Based on their studies, scientists now estimate that these genes potentially allow a healthy person to distinguish and remember around 10,000 different scents (Brownlee et al., 2004).

The groundbreaking discovery of this specific family of genes in 1991 provided scientists with the opportunity to investigate the sense of smell using modern molecular- and cellular-biology techniques. Subsequent studies by Axel, Buck, and others have shown that each olfactory neuron expresses only one type of receptor on its surface. Scents that are comprised of several different odorant molecules bond to these receptors in a particular pattern; for instance, the odorant molecules that characterize the smell of sizzling bacon might stimulate only receptors 2, 45, and 54 (Brownlee et al., 2004). There may be a nostalgic factor involved, certainly, but the savvy practitioner will use whatever tools that have been proven to be effective notwithstanding the etiology of the approach. For example, subtle scents can remind people of childhood events, or traumatic experiences: "A whiff of vanilla may remind some of a fine wine," Ornstein and Sobel point out, "others of grandma's kitchen, the scent of an old lover, or a favorite piece of music, while still others may associate it with a terrible tasting medicine foisted upon a sick child" (p. 69). Because the olfactory sense provides human with more environmental information than the other senses, the current research into identifying specific receptors associated with specific odors has enormous potential for helping people with mood disorders in the future. According to Ornstein and Sobel, "It could well be helpful to understand and perhaps begin to organize our olfactory capabilities. We might be able to control our moods, concentration, and memories, all by smell" (1989, p. 70). Based on the current progress being made in this sphere, scientists may identify these receptors sooner than later.

Effects of Aromatherapy on Mind/Body. In her essay on the influence of pheromones on women's attraction to certain types of men based on their genetic compability, Furlow (1996) says, "Curiously, remembering a smell is usually difficult -- yet when exposed to certain scents, many people may suddenly recall a distant childhood memory in emotionally rich detail. S ome aromas even affect us physiologically" (p. 38). Researchers exploring human olfaction have determined that:

faint trace of lemon significantly increases people's perception of their own health.

Lavender incense contributes to a pleasant mood -- but it lowers volunteers' mathematical abilities.

A whiff of lavender and eucalyptus increases people's respiratory rate and alertness.

The scent of phenethyl alcohol (a constituent of rose oil) reduces blood pressure.

These findings have contributed to the explosive growth in the aromatherapy industry; according to Furlow (1996), "Aromatherapists point to scientific findings that smell can dramatically affect our moods as evidence that therapy with aromatic oils can help buyers manage their emotional lives" (p. 38). According to Ornstein and Sobel, one recent experiment to determine the effect, if any, of fragrances on mind/body involved subjects being wired to physiological monitoring equipment, and then being interrogated with stress-provoking questions, such as "What kind of person makes you angry?" The subjects had their moods measured while changes in their blood pressure, heart rate, respiration, and brain waves were monitored (Ornstein & Sobel, 1989, p. 69). In some cases, before the stressful questioning, a subject sniffed a fragrance. The smell of spiced apple, for example, appeared to modify the stress response: subjects were found to have lower blood pressure, slower breathing, more relaxed muscles, and a slower heart rate. Furthermore, the fragrance-inspired subjects also reported feeling happier, less anxious, and being more relaxed (Ornstein & Sobel, 1989).

In other studies cited by Ornstein and Sobel, the spiced apple fragrance was found to be more effective than eucalyptus or lavender in increasing the brain wave pattern associated with a relaxed but alert state. According to Ornstein and Sobel, "Fragrances inspire us. While savoring a pleasant fragrance we take slow deep breaths and become relaxed. A strong aroma focuses awareness, distracting us from less pleasant thoughts. Pleasant smells may also evoke positive memories or emotions with their associated beneficial physiological effects (Ornstein & Sobel, 1989, p. 69).

Therapeutic Uses of Essential Oils. According to Price et al. (1999), "Essential oils are used extensively by aromatherapists and aromatologists to improve or uplift a patient's state of mind. The effect of the attitude of mind on a person's health is being recognized more and more and essential oils can play an important part here" (p. 4). The vast majority of essential oil use takes place outside the formal medical profession; in fact, some people rely on instructions from one of the numerous texts on essential oils and aromatherapy that are intended for the general public for this purpose. Indeed, these compounds are simple to use and Price et al. suggest that, "It should come as a relief to practitioners that minor everyday ailments such as a sore throat or a winter cold, and even some more serious problems like bronchitis, sinusitis and rheumatism, can be treated in the home easily and successfully, leaving the doctor's time free for the cases requiring expert knowledge" (Price et al., 1999, p. 5). Although this approach to aromatherapy may provide users with all of the desired benefits they seek, more complicated problems and conditions may call for professional assistance from a veteran aromatherapist to achieve the full range of benefits that might be possible. In France, though, from where aromatherapy was introduced to Britain, physicians continue to prescribe essential oils for internal use in capsules or in drops diluted in alcohol (or even in suppositories and pessaries) (Price et al., 1999). These preparations are also used externally in dressings, fumigations, inhalations, ointments and in foot, hand or complete baths. The original concept of aromatherapy in the UK, as promulgated by Mme. Maury, was to use the essential oils in massage only in preparations that had been appropriately diluted in a fixed vegetable oil; unfortunately, this concept led to the belief that this is all there really is to aromatherapy. Price and his colleagues report that they are actively working to correct this erroneous image; however, they also suggest that a complete understanding of what is involved cannot be accomplished until the medical profession takes a more active interest and applies its professional skills to incorporate these valuable techniques to their fullest capabilities in order to bring the benefits of aromatherapy to the healthcare community of the world in the 21st century (Price et al., 1999).

Addiction

Definitions and Background. People can become addicted to virtually anything that brings them pleasure (Bohanan, 1991); however, for the purposes of this study, the term "addiction" will employ the diagnostic criteria provided by DSM-IV for substance dependence. According to DSM-IV, substance dependence is "a maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:

1) Tolerance, as defined by either of the following:

a. A need for markedly increased amounts of the substance to achieve intoxication or desired effect.

b. Markedly diminished effect with continued use of the same amount of the substance.

2) Withdrawal, as manifested by either of the following:

a. The characteristic withdrawal syndrome for the substance b. The same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms.

3) The substance is often taken in larger amounts or over a longer period than was intended (loss of control).

4) There is a persistent desire or unsuccessful efforts to cut down or control substance use (loss of control).

5) A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects (preoccupation).

6) Important social, occupational, or recreational activities are given up or reduced because of substance use (continuation despite adverse consequences).

7) The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (adverse consequences).

Addiction-Related Depression, Anxiety, Mood Disorders (Co-Existing Disorders - PTSD, Smoking, PMS, Insomnia, HIV, Hepatitis C). According to Ba (2003), pain management has recently become a favored topic among aromatherapists, as many are now working in areas other than relaxation massage and are finding that client health needs revolve around quality of life, which for some is based upon pain management. Aromatherapy massage is particularly suited to the treatment of pain due to its soothing and calming qualities. Massage and the application of oils via this method can be localized to concentrate on the area of pain or to achieve general relaxation. While traditionally oils such as wintergreen, rosemary and lavender have been used to help mediate pain, there are also newly discovered and commercially released oils available. One example of these is the previously little known Australian Kunzea (Kunzea ambigua) essential oil. This oil is showing promising effects in relieving the pain of arthritis and muscular sprains and strains (Ba, 2003).

In their book, Healthy Pleasures (1989), Ornstein and Sobel report that patients with insomnia, anxiety, panic attacks, back pain, migraine, and food cravings are now being treated with modern aromatherapy. "For example," they say, "some patients with chronic pain are instructed in deep muscle relaxation while inhaling peach fragrance. Later, the patients simply take a whiff of peach, and the relaxed state is quickly induced" (p. 69). One company now offers a strawberry scented surgical mask to help calm patients under anesthesia. Another corporation has applied for a new patent for fragrances designed to reduce reactivity to stress. Meanwhile, Japanese researchers are studying the effects of aromatherapy on dizziness, nausea, anxiety, and other disorders. And at least one psychoanalyst in France uses the evocative power of vanilla to help patients recall early childhood memories (Ornstein & Sobel, 1989). Aromatherapy is particularly appropriate to ease the discomfort of respiratory illnesses. Colds, flu, sinus infections and bronchitis respond to the anti-inflammatory, decongestant and antimicrobial qualities of certain oils. The inhalation method and aromatic bathing methods are both suitable for the treatment of conditions of the respiratory tract. Thyme and Eucalyptus oils are often employed in treatment of respiratory illnesses but there is a wide range of essential oils that can be used and blended to alleviate symptoms in such conditions (Ba, 2003, p. 127).

Human Behavior Considerations and Uses of Alternative Methods in Treating Additions. A growing number of mental health service providers are incorporating nontraditional techniques for the treatment of addictions within their practices today (Burns, Valadez, Rodriguez & Valadez, 2002). For example, Burns et al. report that studies demonstrating the efficacy of holistic therapies such as yoga, massage therapy, and aromatherapy are beginning to appear in peer-reviewed journals and scholarly reviews. These authors note that, "Other nontraditional or alternative therapies -- meditation, energy healing, diet therapy, herbal therapy, and Rolfing -- have received much trade press attention and research. In light of these trends, it appears a substantial faction of practitioners in the mental health field retain positive attitudes toward these types of therapeutic approaches" (p. 318). According to Brolinson, Ditmyer, and Price (2001), "Patients choose alternative and complementary medical therapies based on their abilities to judge the credibility of information presented by the mass media" (p. 175). The public are not likely able are willing to perform scholarly literature searches of medical journals, and these people are going to naturally tend to rely on what they know from popular media, friends and family members. Further, people who are suffering are more likely to readily accept what sounds like a promising intervention for a problem that would otherwise require mainstream medical care. "Often patients are desperate to improve their health and/or quality of life," Price and his colleagues emphasize, therefore, "accuracy of clinical information often takes a backseat to the quest for improved health" (p. 175). These are important considerations when approaching disease processes that have traditionally been left to the traditional Western healthcare techniques in general, and highly important when identifying effective treatment modalities for women in particular. These issues are discussed further below.

Women and Addiction. According to An increasing number of anecdotal and scientific accounts emphasize the importance of the sense of smell to humans; however, no study to date has systematically examined people's attitudes and beliefs about the olfactory sense (Martin, Apena, Chaudry et al., 2001); nevertheless, by all accounts, aromatherapy appears to be a more efficacious treatment modality for women than for men (Bone & Ellen, 1998). For example, Bone and Allen report that as early as 1932, Laird found evidence that olfactory cues could affect female consumer judgments; his study determined that women's judgments about hosiery quality were influenced significantly by the addition of an unrelated scent (1998). Researchers have investigated human pheromones and women's reactions; women's smell becomes more acute around ovulation when they are most likely to conceive. According to Furlow, "Human sweat, urine, breath, saliva, breast milk, skin oils, and sexual secretions all contain scent-laden chemical compounds. Part of the problem is that not all smells register in our conscious mind -- although they may nonetheless influence mood" (p. 39). While the professional aromatherapist is not likely to resort to bodily exudates for treatment purposes, the fact remains that women experience a heightened sense of smell during some phases of their lives that may account for the reported higher level of effectiveness of aromatherapy for women than men. Women who are taking birth control pills will also have their sense of smell skewed; according to Furlow, "Perfumers who really want to provide that sexy allure to their male customers will apparently need to get a genetic fingerprint of the special someone before they can tailor a scent that she will find attractive. But before men contemplate fooling women in this way, they should consider the possible consequences" (p. 40). The consequences relate to the fact that the effect of birth control pills on women's olfactory sense tends to reverse their natural preferences for certain types of smells - at least pheromones, a factor that remains largely unaddressed in the scientific literature to date. While much remains unclear about the precise etiology of aromatherapeutic agents, a growing number of mainstream medical practitioners are embracing the approach; these initiatives are discussed further below.

Current Research.

a. Science and Aromatherapy. Complementary or alternative medical practices (CAM) are those types of practices that are not generally taught at U.S. medical schools or practiced in U.S. hospitals; these alternative practices are therefore outside of the conventional medical system in the United States. Despite this lack of mainstream interest, a growing number of studies have been conducted in the last few years that have documented the high rates of use of such therapies among groups with various chronic health conditions (Anderson, Manheimer & Stein, 2003). According to these authors, "Groups with different conditions access CAM at different rates, and those with HIV / AIDS, cancer, and musculoskeletal diseases appear to have the highest rates of use" (Anderson et al., p. 401). More precise estimates of complementary and alternative medicine practices are difficult to estimate and the reported levels provided by various surveys may be difficult to compare for at least two reasons:

The therapies and practices that comprise CAM continue to change over time as various CAM therapies are proven safe and effective, incorporated into conventional medicine, and no longer considered CAM; for instance, Anderson and his colleagues note that cognitive-behavioral approaches were once widely regarded as being a CAM but today this method is characterized as being mainstream.

Even at the same point in time, some therapies classified as CAM by some researchers may not be classified as CAM by others (e.g., exercise). Citing a study by Ernest (1997), Anderson et al. suggest that this may help explain why the estimated prevalence of CAM use among people with HIV has ranged from between 27% and 100% in different surveys (Anderson et al., 2003).

Of the 548 patients in the survey by Anderson et al., 45% reported use of at least one CAM therapy during the previous 6 months. While these researchers collected several demographic and clinical factors in their survey, only higher education, lower health-related quality of life, having a regular doctor or clinic and white race were predictive of CAM use in bivariate analysis; in the binomial logistic regression analysis, these same four variables were also found to be independently associated with CAM use. The researchers report that the ordinal logistic regression analysis was nearly identical with the binomial logistic analysis; however, an exception existed between the two analyses in that younger age became a significant predictor in the ordinal model. According to Anderson et al., "This pattern suggests that younger people may not be more likely to use any CAM, but they may be more likely to use multiple types of CAM" (p. 403).

Of the respondents with more than a high school education, more than half (58%) used CAM, compared with high school graduates (44%) and non-high school graduates (37%). In the bivariate analysis, the education level of the respondents was highly associated with any use of each of the CAM domains with the exception of manipulative and body-based methods (p =.096). Furthermore, the level of education of the subjects was positively correlated with the number of therapies used within each of the four CAM domains. Of the respondents who reported having a regular doctor or clinic, education strongly predicted CAM use (p =.0057); however, among the subjects who reported not having a regular doctor or clinic, there was a slight suggestion that education might predict CAM use although it was not statistically significant (Anderson et al., 2003).

Of the commonly used domains, mind-body was the most frequently reported among the recovering drug addicts in the study. Just over one-third (34%) of these respondents reported using at least one mind-body therapy; by contrast, only 14% reported using at least one biological-based therapy (the second most commonly used domain), and alternative medical systems and manipulative methods were used by 10% and 9%, respectively. The three most commonly used individual therapies were also classified as mind-body. According to Anderson et al., "Use of any mind-body intervention was strongly predicted by a poorer health-related quality of life (p =.0016), a higher education (p =.0043), and having a regular doctor or clinic (p =.0058). Use of a biological-based therapy was predicted by education level (p =.0008), white race (p =.0028), poorer health-related quality of life (p =.023) and HIV positivity (p =.024)" (p. 404). Despite these correlations, HIV positivity and white race were not predictive of any of the other domains, although white race was associated with an overall greater use of any vs. no CAM therapy (p =.023). All four of the domains and all of the eighteen of the individual therapies were reported being used by at least one respondent; just over half (55%) of the sample reported using no CAM therapy, 19% used only one, and 26% used two or more; the maximum number of therapies reportedly used was 11 (Anderson et al., 2003).

Finally, there was a high level of self-perceived effectiveness for CAM therapies. Among CAM users, the mean level of self-perceived effectiveness was between "helpful" and "very helpful" (4.1, on a scale of 1-5). These researchers also asked the respondents whether the respondents used any of the CAM therapies for any of four reasons specifically related to recovery from drug addiction. Among the CAM users, 65% reported using CAM to "help relieve or get rid of pain," 57% to "help stop using drugs," 47% to "help relieve withdrawal symptoms," and 13% to "increase the effects of opiates" (Anderson et al., 2003, p. 402).

Table 1. Top 10 Complementary or alternative medical practice therapies used and proportion of respondents who used each therapy [Source: Anderson, Manheimer & Stein, 2003].