Botanicals for Substance Use Disorder

Question 1

What is the name of the herb that supports Bacteroides, reduces Firmicutes, Actinobacteria; lower Firmicutes
à leaner phenotype in humans and animals

Answer 1

Oat Straw

Primary Actions: Nutritive, nervine tonic, sedative, demulcent, vulnerary, antidepressant, hypocholesterolemic, antioxidant
Constituents: Polysaccharides (beta-gluscan), proteins (avenins), fixed oils, phenolics– avenanthramides, flavonoids; indole alkaloid, phytic acid, sterols, vitamin E, starch, protein, lipids
Indications: Anxiety, nervous tension (exhaustion– overwork), IBD (diarrhea, constipation), depression, convalescence; GI upset– nausea, vomit

Cautions/Contraindications: Considered safe, commonly used as food. Safety rating during pregnancy and lactation not established.
Extra Information: Long used as a nourishing nervine, notably soporific (sleep-inducing) in larger doses and when consumed as food. Also an excellent demulcent for GI irritation and inflammation. Applied topically for skin conditions and excellent in baths.
Part Used: Tops or straw, whole plant
Daily Therapeutic Dose Tincture: 9–15 mL (1:5 in 25%)
Daily Therapeutic Dose Infusion or Decoction: 12–24 g dried herb
Pairs Well With: Urtica dioica folia as nutritive tonic
Closest Substitute: Medicago sativa

Other info:
* Topical— contact dermatitis, eczema, seborrhea;
* Cardiovascular— beta-glucan > 3 g/d reduced total cholesterol, LDL, HDL and triglycerides unchanged; bran binds to bile and cholesterol, supports microbiome and increases stool weight;
* T2D— > 3 g/d beta-glucan lower glycemic response to food; increase in viscosity lowers insulin response;
* Microbiome— supports Bacteroides, reduces
Firmicutes, Actinobacteria; lower Firmicutes
à leaner phenotype in humans and animals;

Question 2

This herb works on the nicotinic acetylcholine receptor channel complex and helps with smoking cessation support

Answer 2

Part: leaf, flower, seed
Constituents piperidine alkaloids– lobeline, isolobeline, chelidonine, piperidine, …); bitter glycoside– lobelacrin; chelidonic acid; inflatin;
Actions expectorant; emetic; sialogogue;
Indications— laboured breathing with sense of suffocation, precordial pain, oppression, heaviness; angina or neuralgia extending from chest;
* Alkaloids— act on CNS affecting DNA, RNA, membrane permeability and proteins; blocks nicotinic acetylcholine receptor channel complex
Cautions/Contraindications: Non-toxic, but may cause emesis in doses larger than 1 tablespoon. Safety rating during pregnancy and lactation not established.

• Other— increase urine without loss of Na, Cl, K+; inhibit viruses; alkaloids similar to nicotine but 1/20 – 1/5 potency; rattling cough but poor expectoration, coated tongue; acute asthma; smoker’s cough; respiratory liniment with goose fat;
• Posology— ⌀ tincture 5-40 gtt QD, 1-10 gtt TID/QID;
  60 gtt for (can cause) emesis/nausea;
• Toxicity— low dose simulate, high dose suppress; esophageal burning, nausea, vomit; Tx– GI lavage, keep warm, IV diazepam for seizures, dopamine or phenylephrine if

Question 3

Answer 3

Passifloraceae same as passion flower
* Part— whole plant above ground during fruiting
* Constituents— indole alkaloids– harman, harmane, passiflorine, harmine, harmaline, harmol; cyanogenic glycosides; flavoioids– vitexin, rutin, quercetin, apigenin, kaempferol, lucenin, saponarin; maltol; organic acids; coumarins; sterols; essential oils;
* Actions— analgesic; anticonvulsant; anti- inflammatory; antimicrobial; antitussive; anxiolytic; nervine tonic;

• Traditional uses— insomnia; analgesic; opiate dependence; neurasthenia; dysmenorrhea; epilepsy;
• Passiflora 260mg vs Midazolam 15 mg— 3rd molar extraction; DB, PC, R; Sig 70% calmer and less anxious either Tx; SE– amnesia in several in midazolam arm, none in Passiflora arm; binds GABA-A J Ethnopharm.2013.150(3):281-288.
• Sleep— induces sleep, better sleep cycle on polysomnography; better sleep efficiency; improved wakefulness after sleep;
• Posology— ⌀ 10-120 gtt TID (in substance use disorder the higher dose will likely be more effective); infusion-– 2 g in 150 mL steep covered 15-20 min, TID; topical– 20 g in 200 mL, steep covered; add to
• Combinations— Piper methysticum; Hypericum perforatum; Crataegus oxycantha; Valeriana officinalis;
• Caution— sedative prescriptions, esp. if GABA-A receptor binding;
  Pregnancy and Lactation— minimal to no data; safe from animal data;

Question 4

This herb is used for Leprosy and may make benzodiazepines more potent what is the name of this herb?

Answer 4

** Piper methysticum; Piperaceae
**
* Root—2-3 years old
* Kavalactones (18)—kavain, desmethoxyyangonin, yangonin, dihydrokavain, methysticin, dihydromethysticin; chalcones– flavokavain A, flavokavain B, flavokavain C; alkaloid— pipermethystine;
* Anxiolytic; moderately psychotropic;
* Heavy long-term use may lead to elevated liver enzymes (GGT, ALP)
* May inhibit—CYP 1A2, 2C9, 2C19, 2D6, 3A4, 4A9/11
* Detectable in urine for up to 48h—OH-kavain

• Potentiates GABA-A (sedation); inhibits reuptake of norepinephrine and likely dopamine; bind Cannabinoid Receptor (CB1)— yangonin; inhibition of voltage gated Na and Ca channels; monoamine oxidase B reversible inhibition;
• Anesthetic; anticancer—flavokawains, prostate cancer; anticonvulsant; anti-inflammatory; antipruritic—topical; skeletal muscle relaxant;
• Indications: Insomnia, Neuralgias, Bronchitis—spasmodic cough, Dysmenorrhea, Leprosy–skin rinse, paste
• Dose—fresh root pounded and drunk immediately; tincture to 60 gtt TID; powder 300-3000 mg TID; decoction 4 g in 150 mL water; standardized to 30% kavalactones (range is 24 – 70%), max dose of kavalactone ~ 250 mg/d
• Caution—kavalactones enter breast milk; acetone extracts may compromise liver function as may non-root parts; may potentiate benzodiazepines, EtOH, anesthesia; > 600 mg impairs motor skills
• Desmethoxy-yangonin boosts dopamine and may alter perception

Question 5

This herb is known as an aphrodisiac, anxiolytic, emmenagogue, and has been known to aid in macular degeneration via increased ocular and retinal blood flow and the antioxidant croicin just to name a few, what herb is this?

edative, carminative, diaphoretic, expectorant, stomachic, stimulant, aphrodisiac, emmenagogue, abortifacient; antihypertensive, anticonvulsant, antitussive, anxiolytic, antidepressant, increased ocular and retinal blood flow, antioxidant to lipids; age related
macular degeneration; enhanced heart rate

Answer 5

Saffron or Crocus Sativa a part of the Iridaceae family
Part used: Filaments in flowers; leaf
Constituents: Carotenoids (crocetin, crocins, alpha-carotene, lycopene, zeaxanthin); monoterpene aldehydes (picrocronin, safranal); monoterpenoids (crocusatines); isophorones; flavonoids; B2; Cu, K, Ca, Mn, Fe, Se, Zn, Mg;
Actions: antispasmodic, eupeptic, sedative, carminative, diaphoretic, expectorant, stomachic, stimulant, aphrodisiac, emmenagogue, abortifacient; antihypertensive, anticonvulsant, antitussive, anxiolytic, antidepressant, increased ocular and retinal blood flow, antioxidant to lipids; age related macular degeneration; enhanced heart rate

• Crocin—antagonist of non-selective serotonin receptor agonist mCPP (dose dependent elevation of ACTH, cortisol, prolactin); serotoninergic, noradrenergic, dopaminergic activation
• Combinations—Curcuma longa, Santalum album for itch; Curcuma longa, Azadirachta indica, Santalum album, Rosmarinus officinalis, Aloe vera for scar removal; delirium tremens—with Passiflora incarnata, Papaver somniferum, Lactuca virosa;
  Dose: Infusion 1:80, tincture 5-20 gtt TID; 15-20 mg TID

Cautions:
Abortifacient properties: Saffron, in high doses, is contraindicated in pregnancy due to its potential to stimulate uterine contractions and cause miscarriage.
Neurological effects: It may interact with serotonin pathways, so caution should be used in people taking serotonin-related medications (SSRIs or MAOIs).
Photosensitivity: Some users report increased sensitivity to sunlight when using saffron, although this is less common.
Gastrointestinal upset: High doses could cause gastrointestinal discomfort.

Question 6

Not only is this known for combating viruses i.e. HSV (1&2), Hepatatits, HIV, Influenza and bacteria i.e. Salmonella typhimurium, Corynebacterium diphtheria, Strep agalactiae (mastitis), S. phyogens (pharyngitis) to name a few it increases slow wave sleep in the sleep cycle 3 & 4. What is the name of this herb?

Answer 6

St. Johns Wart or Hypericum Perforatum

Part used: Flower; formerly Clusiaceae
Constituents:* Phenylpropanes, flavonol, biflavones, proanthocyanidins, xanthones, phloroglucinols, amino acids, naphthodianthrones, hypericin, pseudohypericin; bisanthroquinones; essential oils—pinene, alpha-pinene, beta-ocimene, beta- caryophyllene, germacrene; tannins; flavonols, quercetin, hyperoside, isoquercetin;
* Antibacterial—Listeria monocytogenes, Bacillus cereus, Proteus vulgaris, Salmonella typhimurium, Corynebacterium diphtheria, Strep agalactiae (mastitis), S. phyogens (pharyngitis) ,
* Oil—minor burns, wounds, skin inflammation,

• Mental-Emotional—depression; menopausal Sx, ADHD, somatic sx disorder (exaggerated anxiety re: physical sx); obsessive-compulsive disorders;
• Viruses—enveloped esp. with light, HIV-1, viral bronchitis, HSV-1 &2, influenza virus, Mo-MuLV (murine leukemia), duck hepatitis-B,
• Fungi—Microsporum gypsum, Tricophytum rubrum, Aspergillus flavus, Curvularia lunata, Fusarium vasiinfectum
• Smooth muscles—delayed rat gastric emptying
• Sleep—increases slow wave—stage 3 & 4; increased latency to REM, but no effect on sleep continuity, onset, duration, wake-up phases
• Depression—no adverse effect on sexual function
• Dose—300 mg TID (0.3% hypericin); tincture 30-60 gtt TID;
• Interactions—CYP3A4 (~ 50-60% of drugs);
  e.g. alprazolam, SSRI, barbiturates, bupropion, statins, oral contraceptives, digitalis, warfarin, theophylline, HIV protease inhibitors (saquinavir, ritonavir, nelfinavir), HIV non- nucleoside transcriptase inhibitors (efavirenz, nevirapine, delavirdine); à decreased drug dose
• Caution—photosensitivity
• Combinations—viral/bacterial formula, mood

Question 7

If a substance abuse patient got hooked on a med due to pain/muscle spasms and had anxiety this is a good herb to recommend, what is it called?

Answer 7

Piscidia erythrina (piscipula) aka Jamaican Dogwood and is apart of the family called Fabaceae

Part used: Root bark
Constituents: Glycoside—piscidin; isoflavonoids—ichythynone, sumatrol; rotenonens–lisetin, piscerythrone, piscidone; resin; wax; Ca oxalate
Actions: Muscle relaxant, muscle pain, smooth muscle relaxant for hypertension; anxiolytic can low BP; antispasmodic, anti-inflammatory, Antispasmodic comparable to papaverine (PMS), Intermediate between sedation of Valeriana officinalis (high end) and anxiolytic of Passiflora incarnata (lower end)

• Rotenones—fish toxic (fish poison, fish fuddle); insecticide;
• Insomnia from nervous tension, toothaches, otitis pain, orbital neuralgia; migraine HA; spasm of dysmenorrhea, reflex or consumptive cough
  Dose: 12-250 mg TID; max of 400-500 mg/d; decoction 1-2 g/cup BID/TID; tincture 10-60 gtt BID/TID
  Caution: with EtOH, sedatives, opiates, Overdose Sx—decreased sensation, bradycardia, weakness, reduced respiration
  Tx overdose: Establish airway, GI lavage/charcoal, IV fluids, NAC, IV diazepam
  Combinations: Valeriana officinalis, Passiflora incarnata; Viburnum prunifolium, V. opulus

Question 8

This herb is an anticonvulsant, anxiolytic anticonvulsant, antidepressant, vasorelaxant, neuroprotective and sedative to name a few. If an adverse effects i.e. GI upset; paradoxical reactions in approximately 5% (meaning the patient gets wired instead of tired) occurs potentially due to a misdiagnosis of a heat condition excess while adding this warming herb, what herb is this.

Answer 8

Valerian Formerly Valerianaceae
Part used: root
Constituents - volatile oils– borneol, eugenol, isovaleric acid; terpenes– valpotriates, sesquiterpenes; alkaloids– actinidine, chatinine, valerene; aminio acids– tyrosine, glutamine; flavones; lignans; minerals– Cu, Zn, Mn; organic acids;
Actions - analgesic;; anodyne; anticonvulsant; antidepressant; anxiolytic; neuroprotective; sedative; vasorelaxant;
Indications - insomnia from nervousness; anxiety with restlessness; OCD;

Pharmacology:— bind GABA-A– increase release of GABA-A, decrease GABA-A reuptake, decreased GABA-A degradation; binds adenosine A-1 and/or serotonin 5_HT-5alpha receptors; anxiolytic may be through glutamate receptors; 1500 mg comparable to 250 mg mefenamic acid during hystersalpinogography; cognitive function dysfunction less in Valeriana group vs standard of care during coronary artery bypass graft;
* Pharmacokinetics— IV half-life 6-12 min, terminal 6-46 h; oral half-life 2.7-5 h;

Cancer- Valeriana sitchensis inhibits hepatocarcinogenesis vis GABA-A, cascades to apoptosis, inhibition of oxidative DNA damage and cell proliferation
* Posology— ⌀ 30-60 gtt TID/QID; powder– 0.3-
3.0 g TID; infusion of leaf 2 tsp/cup, infuse
12 h, TID/QID; decoction– 2-3 g/150 mL BID/TID; bath– 100g root in 2 L boiling H2O; standardized extract– 0.8% valerenic acid or valepotriates 1-1.5% 160 mg BID, trials to 1100 mg QD;
Cautions GI upset; paradoxical reactions in approximately 5% (meaning the patient gets wired instead of tired)

• Pregnancy and Lactation— little to no data; some historical use during post-partum and lactation;
• Combinations— Humulus lupulus; Passiflora incarnata; Scutelaria lateriflora; Melissa officinalis; Convallaria majalus, Cratageus oxyacanthus;

Isovalerianic Acid, Methylbutanoic Acid

Question 9

Which herb is commonly used as a nervine tonic to support the nervous system in cases of substance withdrawal?

A. Scutellaria lateriflora (Skullcap)
B. Hypericum perforatum (St. John’s Wort)
C. Avena sativa (Oat Seed)
D. Withania somnifera (Ashwagandha)

Answer 9

Correct Answer: C. Avena sativa (Oat Seed)
Constituents and Actions: Avena sativa contains alkaloids, saponins, flavonoids, and B-vitamins, which contribute to its actions as a nervine tonic and mild sedative. These constituents help stabilize the nervous system, relieve anxiety, and restore depleted energy.
Rationale: Known for its calming effects and nutritional support, Avena sativa is ideal for supporting the nervous system, especially during withdrawal, when the body’s stress levels are heightened.
Incorrect Options:
A. Scutellaria lateriflora (Skullcap): Though it has calming properties, it is more commonly used for acute anxiety rather than general tonic support.
B. Hypericum perforatum (St. John’s Wort): Primarily an antidepressant, Hypericum is not classified as a nervine tonic.
D. Withania somnifera (Ashwagandha): As an adaptogen, it supports stress adaptation but is not specifically a nervine tonic.

Question 10

Which herb has a history of use in helping to manage nicotine cravings?

A. Lobelia inflata (Indian Tobacco)
B. Passiflora incarnata (Passionflower)
C. Matricaria chamomilla (Chamomile)
D. Rosmarinus officinalis (Rosemary)

Answer 10

Correct Answer: A. Lobelia inflata (Indian Tobacco)
Constituents and Actions: The active alkaloid lobeline acts similarly to nicotine by binding to nicotine receptors in the brain, thereby reducing cravings. Lobeline’s structural similarity to nicotine also makes it a respiratory stimulant and expectorant.
Rationale: Lobelia inflata is frequently used in smoking cessation as it can mimic nicotine’s effects, making it beneficial for those looking to reduce nicotine cravings.
Incorrect Options:
B. Passiflora incarnata (Passionflower): Primarily used for its anxiolytic and sedative properties, it does not affect nicotine receptors.
C. Matricaria chamomilla (Chamomile): Chamomile is a general relaxant but lacks specific actions to curb nicotine cravings.
D. Rosmarinus officinalis (Rosemary): Rosemary is used for cognitive and circulatory benefits and does not influence nicotine craving reduction.

Question 11

Withania somnifera (Ashwagandha) is particularly noted for which action that supports individuals in recovery from substance abuse?

A. Hepatoprotective
B. Adaptogenic
C. Sedative
D. Diuretic

Answer 11

Correct Answer: B. Adaptogenic
Constituents and Actions: Withania somnifera contains withanolides, alkaloids, and steroidal lactones, which help modulate the body’s stress response and enhance endurance and resilience, which are beneficial in recovery.
Rationale: As an adaptogen, Withania somnifera assists the body in resisting physical and mental stress, supporting long-term recovery by enhancing resilience.
Incorrect Options:
A. Hepatoprotective: Although beneficial to the body’s response to stress, Withania somnifera does not directly protect the liver as other herbs, like Silybum marianum, do.
C. Sedative: It has calming properties but is not a sedative.
D. Diuretic: Ashwagandha does not have significant diuretic effects.

Question 12

Which herb might be used to reduce agitation and nervous tension during substance withdrawal due to its calming and anxiolytic effects?

A. Humulus lupulus (Hops)
B. Scutellaria lateriflora (Skullcap)
C. Piper methysticum (Kava)
D. Taraxacum officinale (Dandelion)

Answer 12

Correct Answer: B. Scutellaria lateriflora (Skullcap)
Constituents and Actions: Contains flavonoids (like baicalin), tannins, and volatile oils, which produce calming effects on the nervous system by reducing excitability and nervous tension.
Rationale: Scutellaria lateriflora is effective in calming the mind, reducing tension, and easing symptoms of nervous exhaustion, making it well-suited for withdrawal support.
Incorrect Options:
A. Humulus lupulus (Hops): Primarily used for sleep and less for general nervous agitation.
C. Piper methysticum (Kava): Although anxiolytic, kava can have hepatotoxic effects, making it less suitable for withdrawal support.
D. Taraxacum officinale (Dandelion): Known for its liver and kidney support, it does not directly calm the nervous system.

Question 13

Which herb is sometimes used in substance withdrawal protocols due to its antidepressant effects that may alleviate symptoms of withdrawal-related depression?

A. Hypericum perforatum (St. John’s Wort)
B. Valeriana officinalis (Valerian)
C. Matricaria chamomilla (Chamomile)
D. Lavandula angustifolia (Lavender)

Answer 13

Correct Answer: A. Hypericum perforatum (St. John’s Wort)
Constituents and Actions: Contains hypericin and hyperforin, both of which modulate serotonin and dopamine levels, leading to antidepressant effects.
Rationale: Hypericum perforatum helps alleviate mood imbalances, especially useful during withdrawal, when depressive symptoms may arise.
Incorrect Options:
B. Valeriana officinalis (Valerian): Primarily sedative, valerian does not directly address depressive symptoms.
C. Matricaria chamomilla (Chamomile): Mildly relaxing but does not affect neurotransmitters directly.
D. Lavandula angustifolia (Lavender): While calming, lavender lacks strong antidepressant effects.

Question 14

Which herb, known for its relaxing properties, might support individuals with alcohol withdrawal by relieving anxiety and promoting better sleep?

A. Passiflora incarnata (Passionflower)
B. Matricaria chamomilla (Chamomile)
C. Piper methysticum (Kava)
D. Rosmarinus officinalis (Rosemary)

Answer 14

Correct Answer: A. Passiflora incarnata (Passionflower)
Constituents and Actions: Contains flavonoids and alkaloids, which produce calming and sedative effects, easing anxiety and supporting sleep without creating dependency.
Rationale: Passionflower’s sedative and anxiolytic effects make it well-suited for managing the anxiety and sleep disturbances common in alcohol withdrawal.
Incorrect Options:
B. Matricaria chamomilla (Chamomile): Gentle relaxant but not as effective as Passionflower for severe anxiety.
C. Piper methysticum (Kava): Though it reduces anxiety, potential liver toxicity makes it less suitable for those with liver concerns.
D. Rosmarinus officinalis (Rosemary): More beneficial for cognitive support, not particularly calming.

Question 15

Which of the following herbs could help address irritability and mild withdrawal symptoms due to its nervine tonic and mild sedative effects?

A. Avena sativa (Oat Seed)
B. Lobelia inflata (Indian Tobacco)
C. Withania somnifera (Ashwagandha)
D. Matricaria chamomilla (Chamomile)

Answer 15

Correct Answer: D. Matricaria chamomilla (Chamomile)

Correct Answer: D. Matricaria chamomilla (Chamomile)
Constituents and Actions: Contains flavonoids (like apigenin) and volatile oils, which have gentle calming and sedative actions that ease tension and irritability.
Rationale: Chamomile is gentle yet effective for addressing mild irritability, nervousness, and sedative effects, supporting individuals with mild withdrawal symptoms.
Incorrect Options:
Rationale: Chamomile is effective for
Incorrect Options:
A. Avena sativa (Oat Seed): While calming, oat seed lacks sedative properties.
B. Lobelia inflata (Indian Tobacco): Often too strong for mild withdrawal as it has stimulant-like effects on the respiratory system.
C. Withania somnifera (Ashwagandha): Ashwagandha helps with stress but is not primarily sedative.

Question 16

In managing substance abuse recovery, which herb may be avoided due to potential interactions with certain medications, including antidepressants?

A. Hypericum perforatum (St. John’s Wort)
B. Withania somnifera (Ashwagandha)
C. Passiflora incarnata (Passionflower)
D. Avena sativa (Oat Seed)

Answer 16

Correct Answer: A. Hypericum perforatum (St. John’s Wort)
Constituents and Actions: Hypericin and hyperforin, both present in Hypericum, induce liver enzymes that metabolize drugs, leading to interactions with antidepressants, anticoagulants, and other medications.

Rationale: St. John’s Wort can affect liver enzymes, leading to interactions that either increase or decrease the effects of various medications, including antidepressants, making it important to monitor in recovery protocols.

Incorrect Options:
B. Withania somnifera (Ashwagandha): Generally safe with most medications and not known for significant interactions.
C. Passiflora incarnata (Passionflower): Few interactions are reported for Passionflower.
D. Avena sativa (Oat Seed): Oat seed is gentle with a very low risk of interactions.