Interview with Jay Holder, D.C.
Dr. Holder is the first American to receive the Albert Schweitzer Prize in Medicine from the Albert Schweitzer-Gesellschaft, Austria. Dr. Holder is Adjunct Professor, St. Martin's College, Milwaukee; held appointment to the faculty at the University of Miami, Center for Addiction Studies and Education and held appointment as post graduate faculty at numerous chiropractic colleges including National College, Life College, Life West and Parker College. He is the creator of Torque Release Technique®, discoverer of the Foundation Point System and Addiction Axis Line in Auriculotherapy, President/Emeritus of the American College of Addictionology and Compulsive Disorders and is Director/Founder of Exodus Treatment Center, a 250 bed addiction facility located in Miami, Florida; Director/Founder of Exodus Israel Addiction and Research Center, Jerusalem, Israel and Chairman of the Israel Certification Board of Addiction Professionals.
TAC: Dr. Holder, you've become regarded as a chiropractor with extensive knowledge on addiction, not only within chiropractics, but in association with other professions. Can you explain a few examples of the patients you have treated and the impact that it has had on their lives.
HOLDER: Well, addicts come from all walks of life. Addiction is a disease, and there are five different kinds: work, food, sex, gambling, drugs, each one of those simple terms are huge arenas of clinical treatments. Food, for instance, is bulimia, anorexia nervosa carbohydrate binging. Of course drugs, that’s from cigarette to heroin, cocaine, alcoholism and so forth. This is an equal opportunity disease, it is a genetically based disease. The gene for addiction was of course discovered at the University of Texas in 1990, by Dr. Kenneth Blum PhD and we know today as the A1 aleal(sp?) of the D2 dopamine receptor defector. This is like saying that diabetes is an equal opportunity disease. You just didn't choose your parents properly, that’s all.
TAC: And how has the success rate been?
HOLDER: The success rate when taking the standard medical model, and when I say that I don't mean surgery or drugs - in the field of the addiction medicine, there is no real medical treatment within the recovery and primary phase of addiction treatment like the 28-day or the 30-day treatment program, or some of those are out-patient programs of 4 to 6 weeks - 95 to 98 percent of those programs are drug free. Even though it’s called addiction medicine, there is no psychiatric need or psychiatric issue, because addiction is not a psychiatric disease. The success rate with the drug-free model, on average in the United States, is about 46 or 47 percent. When you add the torque release model, auricular therapy, which is cranial nerve application, has nothing to do with ear acupuncture at all, and the three amino acids for neurotransmitter replacement therapy, the outcomes come up to about 86 percent. At our treatment program in Miami, we're one of those oldest in the country, the first licensed program in the state of Florida, we're entering our 40th year. We have about a 92 percent success rate for patients who comply with treatment.
TAC: How do you get involved with the nutritional component of treatment?
HOLDER: We're federally and state funded, so we're not able to, because there's no funding for that. But the private pay programs certainly should and some do.
TAC: Do you view the chiropractor’s role in addiction and compulsive behaviour disorders as being one of a technician?
HOLDER: Oh my goodness, absolutely not a technician. No chiropractor should allow themselves to play or fall into the role of technician. The chiropractor is a primary care provider in this field. They are the most logical primary care provider, in that addiction treatment always works best when it’s drug free. And there is no risk of relapse because a well meaning doctor or physician would give some drug - and remember, residential treatment and outpatient programs, for the most part, don't use drug therapy. We're not talking about detox. Detox, medical detox, in hospitals, there's a lot of drug intervention. But addiction treatment begins after detox. Detox is not considered addiction treatment. The role of the chiropractor is primary, the federal government recognizes that, and that's why they're calling upon chiropractors for training, and providing the patients, because they know that the primary care provider best suited to run and manage addiction treatment programs and provide primary intervention resources and addiction treatment is the chiropractor.
TAC: And what is it that attracts you to this market?
HOLDER: Saving lives. Addiction is the leading cause of death in the United States according to the US Department of Health and Human Services. According to the AMA, that claims its heart attack, coronary, cardiovascular, stroke, etc. But it’s not the leading cause of death as reported by the AMA. Like I said that the US Deparment of Health and Human Services, claimed by error of omission, the leading cause of death in the US is drug related, 60% of all manslaughter, 50% of all traffic fatalities, 49% of all murder. I forget some of the other statistics of the top of my head. But you can go to the website. The national office of drug control policy in the White House, who we work close with, [their totals] far exceed [the AMA's]. Traffic fatalities and murder and manslaughter, and 35% of all suicides, make it far and away the leading cause of death in the US. The disease of addiction if not treated successfully, is a fatal disease. It’s also the leading cause of arrest, felony arrest, it’s the leading cause of crime, 92% of all felony arrests in the US are drug related. There are more people in prison for drug related crime, than there are in the US military according to the US government.
TAC: Could you tell our readers about the reward cascade and the impact of the subluxation on an addicted patient?
HOLDER: People who are born with the A1 allele of the D2 dopamine receptor defect have an inability to manifest a normal state of well being. That’s what that gene expresses. And of course, a chiropractor is all about improving state of well being and human potential, through subluxation based techniques, and intervention. The only one that has been studied well within medical sciences and in medical schools, that is the chiropractic system of torque release techniques. And our original work was published in the world’s leading scientific journal, published by nature, which was molecular psychiatry. And we've been published in the journal of psychoactive drugs. Chiropractic's role in addiction milieu is considered mainstream today, by almost every field of expertise, except the chiropractic field, which turns on itself or misunderstands its own purpose. What was the question?
TAC: Could you tell our readers about the reward cascade and the impact on the subluxation?
HOLDER: So this gene defect causes an inability for the brain reward cascade to express itself. Which is a linear cascade of one neural transmitter triggering another triggering another, its like a domino effect, so its linear. So essentially the hypothalamus, producing serotonin, which is going to counteract GABA (Gaba-Amino-Butoric-Acid) which counteracts dopamine, can cause depression, bipolar, all other compulsive disorders, and the addiction. We talk about the five addictions, there’s also all the compulsive disorders, it’s the same gene defect, just with a different name. That’s ADD-DHD, Tourettes, Aspergers, most learning disabilities, some autism, most dyslexia, so we're talking about a tremendous affect within the population of young adults, certainly adolescents and children. The chiropractic can play a tremendous role, where we have had dramatic objective changes after just one or two adjustments in b-mapping of the brain to determine restoration of normal brain function, pre and post, using brain electrical activity maps, p300 wave testing, EEG, etc. So the brain reward cascade, a person is born with an inadequate one if their born with this gene defect and that’s why they seek pleasure and drugs to feel better. Then they get caught up in that cycle and they become addicted and then it goes downhill. Then this population would have an abhorrent brain reward cascade. Subluxation based torque release technique restores a normal brain reward cascade.
TAC: Are there certain methods of chiropractic treatment or techniques that you feel are most successful for the treatment of addicted patients?
HOLDER: Well, first of all let me say this: this article in no shape or form should suggest that chiropractic treats addiction cause it doesn't treat any disease or condition or symptom. It allows for the adjustment of the subluxation to remove the interference for a normally functioning state of well being and human potential by allowing innate intelligence to restore an abhorrent brain reward cascade. And reward deficiency syndrome issues. So it’s important that we understand that the foundation for successful addiction treatment is the addiction counsellor. In dealing with the psychosocial aspects of addiction, that’s the front line, in the trenches, that comes first. The adding of three other modalities, to the model of addiction treatment, would be torque release technique as the only one so far that has been credited with peer review publication documentation, and research. and 25 to 30 years of the same research on the neurotransmitter replacement therapy using the three amino acids on an empty stomach three times a day and auricular therapy. And auricular therapy is now in all the drug courts in the US cause it reduces the rearrest rate from 75% to 5%. Even in Australia first offenders of drug related crimes are required to have one year of torque release technique and auricular therapy, or they go to jail. The drug court strategy we started here with Janet Reno in the Miami drug court, and that 3 year study was 4296 adults and three years later we were able to see an impact in the rearrest rate from 75% to 5%. Every county has a drug court strategy. Some of them are using all of the treatments, some of them are using none of the treatments. It varies from jurisdiction to jurisdiction. So the primary treatment model is counselling. Group therapy, one to one psychotherapy, that’s what we mean by counselling. You add to that torque release technique, auricular therapy which has nothing to do with ear acupuncture, its four-cranial nerve system of the ear taught in most medical schools. We use the UCLA school of Medicine model. We did the first government funded studied in auricular therapy. In fact there are no needles, this is not acupuncture, it has nothing to do with acupuncture in the ear. Its a neurological, subluxation based system. And so auricular therapy, the neurotransmitter replacement therapy with the amino acids, torque release technique, but most importantly the counseling.
TAC: What’s the most difficult thing that you have to deal with in achieving your highest success rate in getting the patient as close as possible to normal health?
HOLDER: That’s the very good question. In the field of addiction treatment, it is well known, everyone has to agree, the hall mark of the disease of addiction, and the psycho-social component is denial. Denial is not a river in Egypt. Denial is a psychosocial dynamic where a person actually believes or remakes his reality to believe that there's no problem, that everyone else has a problem, they deny the issue. Breaking down that denial is everything. A person won’t come to treatment unless they've broken down that denial. They have to reach bottom, and reaching bottom, you've heard that, and that terminology means that that’s broken down their denial. The problem is most people who reach a bottom die before they come into treatment. So the idea is successful intervention. To get somebody into treatment, is the way to go. What’s the barrier? Breaking down that denial. So that during the intervention they'll realize what their reality really is. That they really are killing themselves with a smile on their face. Denial means that the addict has come to believe that really they're not harming themselves. They deny reality so that they can continue their addiction. This is not a psychiatric disease. There are psychiatric disease that are co-morbid, that co-exist with the disease of addiction. Like the person can have alcoholism, or be addicted to heroin, and at the same time be bipolar.
The biggest stumbling block is being skilled enough to work with a patient even before treatment, through the intervention process, to get them into treatment. The only way their going to come to treatment, because there are no locked facilities. Oh I know what I was saying, when you have two different disease at the same time it’s called a dual-diagnosis. And typically when you say that, that buzzword in the field, implies there’s a disease and there’s along with it a psychiatric disease.
A dual diagnosis then would suggest there is a co-occurring psychiatric disease. But we don't use psychiatric methods to treat addiction. It has always failed miserably. And the leadership, in the field of medicine, that are medical doctors, that board of certification, in psychiatry, would be the first to tell you that addiction is not a psychiatric disease.
TAC: How do you view the use of pharmaceuticals in this type of practice?
HOLDER: As a last resort. Again, its primary role would be in those few cases where medical detox is necessary. Heroin, the worst case of heroin, does not require a medical detox, but methadone does. Significant alcoholism does, people on barbiturates or benzodiazopemes would need a medical detox to avoid seizure after an abrupt discontinuances of those drugs, such as alcohol, or methadone, or suboxone, or the ones that i mentioned. But that is considered detox, not addiction treatment. Addiction treatment starts after that. Because a person cant abruptly discontinue certain things. But just those things I mentioned. So cocaine, and heroin, and oxycodone, and marijuana. No matter if its crack or its snorted or its injected, whatever, it does not require a medical detox. So only in those cases, as a last resort, would we review the patients needs and recommend a medical detox if necessary, then we do that.
TAC: Are many patients addicted to pharmaceuticals?
HOLDER: Yes. And becoming more and more so because of the tremendous explosion of these so called pain-management clinics that advertise very clearly, if you have pain come and get your oxycontin. And the federal government is cracking down on them. I would expect that after a year or two years there will be no pain-management clinics. Laws are being promulgated as we speak to shut them down. The occasional misunderstanding of a good-intentioned medical doctor, who didn't realize that this person has a genetic defect, or an incompetent brain reward cascade. And gives that person percodan for the tooth that was pooled, is a well meaning person is not trying to take advantage of anybody, but those people are addicted. And that’s iatrogenic, and so there's a lot of that. But these pain-management clinics that are 'medically based' are an atrocious abomination and have created an epidemic that is way worse than what was the case ten years ago.
TAC: What about supplements?
HOLDER: Well, supplements are always important depending on what the person is recovering from. If its bulimia it would be several things. It would be different if its anorexia nervosa. If its alcoholism. There are target organs depending on the addiction. If it’s alcoholism it’s the liver, esophagus, pancreas. That makes sense to have a best intervention resources that are nutritionally based. But keep in mind that across the board, whether its compulsive disorder or the five addictions - work food sex gambling or drugs - the three amino acids should be considered a nutritional approach as well, but everybody gets that. The three amino acids are L-tyrosine, L-glutamine, DL-ethanolamine, and L-tryptamine, each one of those 750 mgs each three times a day, but it only works on an empty stomach. But its not a nutritional approach, you're not supplementing. These three amino acids are used as enkeph-alinase inhibitors, when taken on an empty stomach. If taken with food, they're useless in this dynamic. But still could be considered nutritional because they are amino acids.
TAC: Could you tell us a little bit about the integrator?
HOLDER: The integrator is the first chiropractic instrument to be cleared by the FDA with a 510K for an indication of the adjustment of the vitreval subluxation. It doesn't do what any other adjustment instrument does. It is a toggle recoil instrument. Primary subluxations are usually three letter listings. In other words they're three-dimensional on an XYZ axis. So simultaneously your listings could be posterior lateral or inferior. and you're adjusting by hand your hand in a toggle recoil are moving in more than one direction at the same time to correct one direction against another versus superiority or inferiority. Such as torque. People don't understand that torque in chiropractic is a line of drive for superior inferior direction for the listing. the integrator reproduces what the hands were intended to do in a perfect toggle recoil at a ten-thousandth of a second. Its three dimensional.
Will reproduce all the directions of the dynamic thrust or the adjustment by hand. Including recoil which is internal, not in the hand. The integrator, you don't squeeze it to fire it. It doesn't have a door-stopper on the end. It has a reproducible pisiform, we went to three thousand human pisiforms to find the average size and shape and density or sponginess what we called durometer of the pisiform. So the integrator, unlike other instruments, we're not mechanical door openers or modified dental instruments. The integrator was designed to reproduce a perfect toggle recoil by hand delivered by a trained chiropractor. However, the integrator is not required to practice torque release techniques. There are many chiropractors who were graduates of chiropractic schools who were not taught or trained in toggle recoil. And there are those chiropractors who do really well by hand and were trained in toggle recoil learn in several years that being on all the time with that perfect dynamic thrust with toggle recoil is really hard to reproduce time and time again. So the integrator comes in real handy. However in torque release technique you can use your hands, you can use SOT blocks, you can use Thomson drop-keys, you can use an integrator, we don't care what you use as long as the chiropractor can deliver the adjustment. Torque release techniques is not about the integrator, it’s about knowing where and where not to adjust, and making a differential diagnosis to only adjust the primary subluxation, avoiding secondary and tertiary subluxations which are symptoms of the primary. We don't adjust symptoms.
TAC: Explain what the program in Louisiana is about and how you are involved in the training of experts in compulsive and addictive behaviour?
HOLDER: On that I'll give you. Do you have the handouts? Please refer to the July in Dynamic Chiropractic July 29th edition 2010 front page story is very specific and accurate. Glean from that what you want. Also included is a letter from different state agencies in Louisiana to chiropractors. And then on the back a full explanation on how that can work. The government is starting with Louisiana. We expect over a period of time its winding up happening in every state.
TAC: Could you describe what a typical day in an addiction and obsessive compulsive disorder practice would be like?
HOLDER: Obsessive and compulsive. I don't know if that’s important. It’s very exciting. There's no burnout in this field. For a chiropractor to practice in such an exciting milieu, it beats the heck out of low back pain and neck pain day after day after day. There is no burnout in this field.
TAC: Any final words for our readers?
HOLDER: BJ Palmer, had Clearview sanitarium, wrote chapter and verse on the role of the subluxation and the chiropractor in the addiction dynamic. 80% of all the patients of Clearview Sanitarium were alcoholics and other disorders, including schizophrenia, but mostly alcoholics. This is nothing new. We're bringing now, you know the world has caught up to understanding what chiropractic is all about. Its principles and its virtues. Therefore, what was happening in the 20s, 30s, and 40s, with BJ Palmer that was looked as bizarre and whacko, today everyone is finding out that everything that BJ said and everything that DD said was right on today. This is not an unusual situation. This happens in other fields too. When somebody comes too early, too soon.
If a chiropractor wants to know what to do at this point, other than of course training in torque release technique and auricular therapy. The answer would be the American College of Addictionology and Compulsive Disorders is an ICA for board certification in addiction. But it is also the board certification for all addiction for all professionals, and is recognized for licensure, if a person didn't have a license, and entering this diplomate program. It is a portal of entry for state licensure and addiction professional in every state and 42 foreign countries, you go into the military as an officer, its very well recognizes. However for a chiropractor that is already licensed, this becomes diplomate board certification, it allows them to specialize in this field. There are a lot of procedures that can they can be reimbursed for through insurance, that without this training would not occur. So what could that chiropractor do? Enter into the diplomate program by the American College of Addictionology and Compulsive Disorders. It is the least expensive diplomate program that a chiropractor can enter and it is the shortest requirement. It doesn't take three years. It can actually be done within a year. The American College of Addictionology has already certified thousands of chiropractors and other healthcare professionals over the last 20 years. So at the end of the article, for further information, contact the Holder Research Institute or the American College of Addictionology at 305 535 8803 or go to www.torquerelease.com, or you can go to the American College of Addictionology website which is www.acacd.com If there are any questions readers can call that phone number. There's a faculty assisting, it’s not a J. Holder program, these are famous people, we have the head of the White House under the elder Bush, Philip Diaz, deputy director of national drug policy under the GHW Bush White House. Joseph Bradley who flies all over the world giving interventions. Held in Orlando and Las Vegas, faculty of 15 people check out their bios.