top of page

The Spine, the Brain, and the Biochemistry of Craving: How Chiropractic Nervous System Regulation May Transform Addiction Recovery

Addiction is not a failure of will. It is a systemic disorder of nervous system dysregulation — a disease that rewires the prefrontal cortex, hijacks the hypothalamic-pituitary-adrenal (HPA) axis, suppresses heart rate variability (HRV), activates neuroinflammatory cascades, and encodes itself in the epigenome. This paper synthesizes over 30 peer-reviewed studies to argue that subluxation-based chiropractic care — by restoring optimal afferent input to the central nervous system — may act as a powerful neurophysiological adjunct to addiction treatment. Through prefrontal cortex modulation, autonomic rebalancing, cortisol regulation, endogenous opioid stimulation, and cytokine attenuation, chiropractic adjustments appear to address the precise biological substrates that maintain addictive behavior. The evidence is frontier-facing, the mechanisms are scientifically grounded, and the clinical opportunity is enormous.

Image by Myriam Zilles
Prescription Medicine
Image by Hennie Stander

Introduction: Addiction as a Disorder of Nervous System Dysregulation


Introduction

When researchers and clinicians ask what can chiropractic do for addiction, they are asking the wrong question. The right question is: what does addiction do to the nervous system — and can chiropractic help restore what addiction has taken away? The answer, emerging from converging lines of neuroscience, is a cautious but compelling yes.

​

Addiction is defined by the National Institute on Drug Abuse as a chronic, relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences. But that definition barely scratches the surface of what it does biologically. Koob and Volkow's landmark three-stage neurocircuitry model1 identifies three overlapping systems that are progressively dismantled by substance use: the reward/binge system centered in the basal ganglia, the stress/anti-reward system rooted in the extended amygdala, and the executive control system governed by the prefrontal cortex.1 Critically, this is not simply a dopamine story. It is a whole-nervous-system story — and that is precisely where chiropractic enters the conversation.

​

As Volkow, Koob, and McLellan articulated in the New England Journal of Medicine,2 addiction involves the progressive desensitization of reward circuits, the amplification of stress reactivity, and the weakening of prefrontal regions responsible for decision-making, inhibitory control, and self-regulation.2 These are not metaphors — they are measurable neurobiological changes that create a body in chronic crisis. And a body in chronic crisis is a nervous system in chronic dysregulation. That is the domain of chiropractic care.

The Addicted Brain: Prefrontal Cortex Failure and Why It Matters

No single region of the brain is more devastated by chronic addiction than the prefrontal cortex (PFC). Goldstein and Volkow's iRISA model — Impaired Response Inhibition and Salience Attribution3 — describes how addiction simultaneously cripples the brain's top-down inhibitory control while flooding it with exaggerated salience responses to drug cues.3 PFC hypoactivity during emotional or cognitive challenges is a reliable predictor of worse treatment outcomes and higher relapse rates. The person cannot stop because their stop system is broken.

​

This is where one of the most important papers in the history of chiropractic neuroscience becomes directly relevant. Lelic et al. (2016), published in Neural Plasticity,4 used 62-channel EEG with brain electrical source analysis (BESA) to demonstrate that manipulation of dysfunctional spinal joints altered somatosensory evoked potential (N30) amplitude by 16.9% — and that brain source localization pinpointed the change specifically to the prefrontal cortex, which showed a 20.2% reduction in activity compared to a control intervention where no changes occurred.4 No change was observed in the primary somatosensory cortex, cingulate, or insular sources. The prefrontal cortex was the unique target.

​

This is not a peripheral pain mechanism. This is a brain-level event. And the prefrontal cortex it modulates is the same prefrontal cortex that governs impulse control, emotional regulation, decision-making, and the ability to resist craving.3 We propose that subluxation-based chiropractic adjustments — by normalizing dysfunctional spinal afferent input — may help restore the prefrontal regulatory capacity that addiction systematically erodes. This hypothesis is testable, biologically grounded, and represents one of the most exciting frontiers in integrative addiction medicine.

​

Supporting this further, Haavik et al. (2017) demonstrated in Brain Sciences5 that spinal manipulation increased maximum motor evoked potentials and movement-related cortical potentials — with no changes in F-wave measures — confirming that the effects originate from descending cortical drive, not spinal cord changes.5 The brain is changing, top-down. And in a randomized crossover trial in chronic stroke patients, Holt et al. (2019)6 documented a 64.2% increase in muscle strength and a 54% increase in supraspinal V-wave ratios after a single chiropractic session — effects that confirm brain-level neuroplastic changes occur even in severely compromised neurological populations.6

The Autonomic Nervous System, Heart Rate Variability, and the Biology of Relapse

Addiction is not only a brain disease — it is a disease of the body's stress-regulation machinery. Individuals with substance use disorders are almost universally characterized by sympathetic nervous system dominance, blunted vagal tone, and chronically suppressed heart rate variability (HRV). This is not a side effect of addiction — it is a core biological feature that drives craving and relapse.

​

The evidence for this is now robust. Moon et al.'s 2024 comprehensive narrative review7 confirmed significantly decreased resting HRV across opioid, cocaine, and methamphetamine use disorder populations, with lower HRV strongly associated with increased stress, craving intensity, and greater addiction severity.7 And in a groundbreaking prospective ambulatory study, Eddie et al. (2023)8 demonstrated in 42 adults in early recovery from alcohol use disorder that higher parasympathetically-mediated HRV predicted significantly greater percent days abstinent over 90-day follow-up — while those with lower HRV continued drinking at baseline rates.8 The autonomic nervous system is not just correlated with recovery. It predicts it.

​

In 2025, this connection became even more concrete. Eddie et al.'s Phase 2 RCT9 of 115 adults with substance use disorder found that a wearable HRV biofeedback intervention produced a 64% reduction in alcohol and drug use days (OR = 0.36).9 Improving HRV is not simply a wellness marker — it is a therapeutic target with measurable addiction outcomes.

​

Can chiropractic improve HRV? The evidence suggests yes. Zhang et al.'s multisite clinical study (2006)10 across 96 chiropractors and 539 patients found that a single chiropractic adjustment significantly increased SDNN and high-frequency HRV — objective markers of parasympathetic activation — while simultaneously reducing pain intensity.10 The most recent systematic review and meta-analysis by Sampath et al. (2024)11 of 14 RCTs found regional specificity in ANS responses to spinal manipulation, acknowledging that while evidence quality remains low overall, cervical manipulation shows the most consistent effects on high-frequency HRV.11 The mechanistic pathway from chiropractic adjustment → improved HRV → reduced relapse risk is scientifically coherent, clinically relevant, and deserves rigorous prospective investigation.

The HPA Axis, Cortisol, and the Stress–Relapse Cycle

The hypothalamic-pituitary-adrenal (HPA) axis is ground zero for stress-driven relapse. Sinha's foundational 2008 review12 established that chronic stress dysregulates corticotropin-releasing factor pathways, autonomic arousal systems, and central noradrenergic signaling — creating a lasting biological vulnerability where stress becomes one of the most powerful triggers for relapse.12 In a 2024 update in the Journal of Clinical Investigation, Sinha confirmed13 that chronic HPA activation and reduced HRV together predict both addiction risk and relapse in recovering individuals.13 These are precisely the systems that chiropractic care is positioned to address.

​

Chiropractic's effects on the HPA axis are emerging as one of the most exciting areas of biomarker research. In the most comprehensive chiropractic biomarker RCT ever conducted, Amjad et al. (2025) published in PLOS ONE14 followed 106 randomized participants through 12 weeks of chiropractic spinal adjustments. At 16-week follow-up, the chiropractic group showed significantly lower blood cortisol (P = 0.024), lower IFN-γ (P < 0.05), and lower TNF-α (P = 0.028) compared to controls.14 The same study found significantly higher BDNF — brain-derived neurotrophic factor — at 12 weeks (P = 0.009).14 BDNF is the molecule of neuroplasticity itself: it drives learning, memory consolidation, and the neural rewiring that makes durable recovery possible.

​

Preliminary clinical evidence adds texture to these biomarker findings. Hughes' 2020 case report in the Journal of Contemporary Chiropractic15 documented measurable declines in salivary cortisol alongside improvements in anxiety severity over a course of chiropractic care — the same cortisol profile that would, if replicated in addiction populations, directly attenuate stress-mediated craving.15 Additionally, Vernon et al.'s controlled trial16 remains the first evidence that cervical spinal manipulation stimulates plasma beta-endorphin release — the body's endogenous opioid — a finding with profound implications for individuals recovering from opioid use disorder whose natural reward chemistry has been devastated by years of pharmacological override.16

Neuroinflammation: The Hidden Fuel of Addiction That Chiropractic May Address

The emerging neuroimmune theory of addiction is one of the most important scientific developments of the past decade. Cui, Shurtleff, and Harris (2014)17 established that all major drugs of abuse activate microglia — the brain's resident immune cells — producing TNF-α and IL-1β that disrupt synaptic plasticity in reward circuits and accelerate neurotoxicity.17 Li et al.'s 2024 comprehensive neuroimaging review18 confirmed elevated microglial activation markers in the cingulate cortex, VTA, and amygdala of individuals with alcohol use disorder — brain regions governing motivation, decision-making, and emotional memory.18 Neuroinflammation is not peripheral to addiction. It is encoded in the brain structures that drive it.

​

Chiropractic's immune-modulating effects are therefore far more significant than previously appreciated. Teodorczyk-Injeyan et al.'s controlled trial (2006)19 demonstrated that a single thoracic HVLA adjustment produced approximately a 20% attenuation of LPS-induced TNF-α and IL-1β production in 64 asymptomatic subjects — and that this effect was mediated through a central mechanism, not local inflammation.19 TNF-α and IL-1β are the same cytokines that neuroinflammation research identifies as core to addiction pathology. In a 2021 follow-up, the same research group demonstrated that spinal manipulative therapy significantly reduced IL-6 in chronic low back pain patients and increased IL-2 (an immunoregulatory cytokine), hypothesizing activation of a central anti-inflammatory reflex20 mediated through the autonomic nervous system.20 The Amjad et al. 2025 RCT further confirmed sustained TNF-α reduction at 16 weeks with repeated chiropractic care.14

​

We propose a hypothesis: by reducing circulating pro-inflammatory cytokines through central nervous system-mediated mechanisms, subluxation-based chiropractic adjustments may lower the neuroinflammatory burden that perpetuates microglial activation in addiction-relevant brain regions. This is a testable hypothesis that deserves dedicated clinical investigation.

The Insula, Interoception, and the Body's Memory of Craving

Perhaps the most underappreciated neuroscience insight relevant to chiropractic and addiction involves the insula — the brain's interoceptive processing hub. In a landmark 2007 study published in Science, Naqvi et al.21 found that smokers who sustained insula damage were able to quit smoking immediately, easily, and without relapse — with one patient famously reporting that "my body forgot the urge to smoke."21 The insula was the only brain region where damage significantly predicted addiction disruption. The odds ratio was 136.49. This finding established that addiction is not just a reward memory — it is a body memory, stored in the interoceptive machinery that tracks how the body feels from moment to moment.

​

Menon and Uddin's salience network model (2010)22 extended this, positioning the anterior insula as the critical hub of a salience network that detects interoceptive signals and switches the brain between the default mode network (self-referential rumination) and the executive control network (goal-directed behavior).22 In addiction, this switching mechanism is chronically biased toward craving — every bodily signal is interpreted through the lens of drug seeking. Miller, Kiverstein, and Rietveld's predictive processing account of addiction (2020)23 reframes this neuroscientifically: addictive substances create aberrant precision-weighting of interoceptive predictions, essentially making the body's internal model insist that substance use is the only path to homeostasis.23

​

Chiropractic adjustments deliver rich, novel, high-fidelity proprioceptive and somatosensory afferent input to the central nervous system. This input travels through the same pathways that feed the salience network. We hypothesize that by introducing new, coherent somatosensory signals — particularly through correction of subluxation-related afferent disruption — chiropractic care may help recalibrate interoceptive processing, introduce productive prediction errors into the body's addictive model, and reduce the salience of drug-related internal cues. This is a frontier-facing hypothesis that unites chiropractic philosophy, predictive processing theory, and addiction neuroscience in a single coherent framework.

Chiropractic, Opioids, and the Prevention of Addiction

The most concrete clinical data connecting chiropractic to addiction outcomes exists in the opioid-sparing literature — and it is extraordinary. The 2020 systematic review and meta-analysis by Corcoran et al. in Pain Medicine24 analyzed six studies involving tens of thousands of patients and found that chiropractic users with spinal pain had 64% lower odds of receiving an opioid prescription (OR = 0.36).24 This is not a marginal finding. In the context of an opioid epidemic that has claimed over 500,000 lives in two decades, a 64% reduction in opioid exposure from an accessible, non-pharmacological intervention represents one of the most clinically significant preventive findings in modern healthcare.

​

But the most remarkable data arrived in 2025. Trager et al.'s retrospective cohort study25 — the first ever to examine opioid use disorder as a direct outcome — used the TriNetX Research Network of over 216 million patients. In nearly 50,000 propensity-matched adults with new low back pain, those who received chiropractic spinal manipulative therapy had an 80% lower risk of developing opioid use disorder compared to those who received ibuprofen (0.24% vs. 1.51%, RR = 0.20).25 They were also 77% less likely to develop long-term opioid use.25 Chiropractic care is not simply reducing opioid prescriptions — it may be preventing the disease of opioid addiction itself.

​

This is directly supported by Passmore et al.'s 2022 retrospective analysis26 at a publicly funded inner-city clinic, which demonstrated that pain and opioid use both significantly decreased over a course of chiropractic care in vulnerable, low-income populations.26 The pain-opioid-addiction pipeline is one of the most well-established pathways to substance use disorder — and chiropractic care represents a powerful intervention point at the beginning of that pipeline.

The Residential Treatment Evidence and the Reward Cascade Hypothesis

The most striking addiction-specific clinical signal in the chiropractic literature remains the study published by Holder, Duncan, Gissen, Miller, and Blum in Molecular Psychiatry (2001).27 In a randomized, placebo-controlled, single-blind three-arm trial at a residential addiction treatment center, 98 patients were assigned to standard treatment, sham chiropractic, or genuine subluxation-based chiropractic adjustments. The group receiving authentic chiropractic care achieved 100% 28-day program completion. The sham group achieved 75%. Standard care achieved 56%.27 Chiropractic participants also reported significantly lower anxiety, made fewer nurse visits, and demonstrated fewer withdrawal-related complaints. These outcomes exceeded national completion averages.

​

This study was published as a supplement abstract — not a full peer-reviewed trial — and the lead investigator had commercial interests in the technique used. These are important limitations. We present it not as definitive evidence, but as a compelling and unreplicated signal that demands rigorous modern replication. A prospective RCT with contemporary CONSORT standards, pre-registration, intention-to-treat analysis, and biomarker endpoints (HRV, cortisol, BDNF, TNF-α) measuring 90-day abstinence would be among the highest-value studies in integrative addiction medicine today.

​

The theoretical framework underlying these findings is Reward Deficiency Syndrome, a model proposed by Blum et al. (2000)28 proposing that a hypodopaminergic state — a brain chronically unable to generate adequate reward from normal experience — drives compulsive substance seeking as a compensatory attempt to feel baseline well-being.28 This model remains theoretical and is not recognized by the DSM, and a landmark 2019 JAMA Network Open meta-analysis by Jung et al.29 found that the specific DRD2 A1 allele association central to RDS theory was attributable to methodological artifacts rather than genuine biological signal.29 The broader concept of dopaminergic vulnerability — confirmed by PET neuroimaging showing reduced D2 receptor density in addicted individuals — remains scientifically valid even if its specific genetic underpinnings are more complex. Addiction has a highly polygenic architecture, as the landmark 2023 GWAS by Hatoum et al.30 in over one million individuals confirmed — with risk distributed across hundreds of variants affecting common neurobiological pathways.30

Epigenetics: The Long Game of Nervous System Restoration

Addiction rewrites the genome's operating instructions. Robison and Nestler's 2011 review in Nature Reviews Neuroscience31 identified the transcription factor ΔFosB — which accumulates in the nucleus accumbens with chronic drug use and persists for weeks after cessation — as a molecular switch that sensitizes reward circuitry and may underlie the enduring nature of addiction.31 Histone acetylation, DNA methylation changes, and non-coding RNA regulation all encode the addicted state at the molecular level. But crucially, as Nestler and Lüscher confirmed in 2019,32 epigenetic modifications are reversible — life experience shapes the epigenetic landscape in both directions.32

​

No studies have yet directly measured the epigenetic effects of chiropractic adjustments. That is a frontier to be explored. But we know that behavioral interventions reducing stress and inflammation — the physiological states that chiropractic demonstrably modulates — alter DNA methylation and histone modification patterns in ways that are therapeutically relevant. The Amjad et al. 2025 RCT's finding of elevated BDNF at 12 weeks is particularly significant: BDNF is a key mediator of epigenetic neuroplasticity in recovery circuits.14 We propose that repeated, consistent chiropractic care — by reducing cortisol, attenuating TNF-α and IL-1β, enhancing parasympathetic tone, and elevating BDNF — creates a biological environment more conducive to beneficial epigenetic remodeling in addiction-relevant circuits. This is a testable hypothesis and a research agenda waiting to be claimed by the chiropractic profession.

Clinical Integration: What Chiropractic Offers That No Drug Can

Chiropractic care is not a cure for addiction. No reputable chiropractor would claim it to be. But what chiropractic offers is something profoundly different from pharmacological approaches — and in the context of addiction recovery, that difference is a feature, not a limitation. Chiropractic care does not introduce exogenous chemicals. It does not activate reward pathways through pharmacological override. It does not create physical dependence. Instead, it stimulates the body's own regulatory systems — the prefrontal cortex, the parasympathetic nervous system, the HPA axis, the endogenous opioid system, the immune-inflammatory cascade — to produce internal states of greater balance, calm, and resilience.

​

When individuals in recovery experience less anxiety, clearer cognition, better sleep, and reduced physical pain — all outcomes clinically observed in patients receiving chiropractic care — they are better positioned to engage meaningfully in counseling, maintain motivation for group therapy, tolerate the discomfort of withdrawal, and sustain the behavioral changes that long-term sobriety requires. The Holder residential data suggests that this translates into dramatically improved program completion. The Trager 2025 data suggests it translates into dramatically reduced opioid use disorder risk. The Eddie 2023 data suggests that the HRV improvements chiropractic produces may directly predict abstinence outcomes.

​

The convergence of these findings across multiple research domains — prefrontal neuroscience, autonomic medicine, HPA axis biology, neuroimmunology, epigenetics, and clinical outcomes research — points toward a single conclusion: subluxation-based chiropractic care targets the precise biological architecture of addiction through mechanisms that are scientifically coherent, clinically observable, and ripe for rigorous investigation. The frontier is open. The evidence is building. The patients who need this care are waiting.

Conclusion: Toward a New Role for Chiropractic in Addiction Medicine

Addiction devastates the nervous system — and nervous system regulation is the core of chiropractic care. This is not a coincidence. It is a convergence that demands clinical attention and scientific investment. From Lelic et al.'s prefrontal cortex findings to Trager et al.'s 80% OUD risk reduction, from Eddie et al.'s HRV-recovery bridge to Amjad et al.'s BDNF and cytokine data, a scientifically coherent case is emerging that chiropractic adjustments can modulate the exact biological systems that addiction has disrupted.

​

The most honest summary of where the evidence stands is this: the mechanistic foundations are strong, the preliminary clinical signals are remarkable, and the full clinical story has not yet been written. It needs to be written — in the form of well-designed, prospective, adequately powered clinical trials measuring addiction-specific outcomes alongside the neurophysiological biomarkers that chiropractic demonstrably influences. Retention rates. Relapse at 90 days. HRV diurnal slope. Cortisol awakening response. BDNF. TNF-α. These are the endpoints that will validate or refine this framework.

​

Chiropractic has long known that the spine is the gateway to the nervous system, and the nervous system is the gateway to health. What we are now beginning to understand is that this gateway opens into the very biology of addiction. The subluxation-based chiropractor working with a patient in recovery is not merely reducing back pain or improving posture. They may be recalibrating the prefrontal brake system that prevents relapse, restoring the parasympathetic regulation that predicts abstinence, attenuating the neuroinflammatory cascade that perpetuates craving, and elevating the neuroplasticity molecule that makes recovery possible. That is a vision of chiropractic's role that is worthy of this profession — and worthy of the patients who trust us with their healing.

References

Why Prospective Patients Should Consider Chiropractic for Addiction Recovery

  1. Koob GF, Volkow ND. Neurobiology of addiction: a neurocircuitry analysis. Lancet Psychiatry. 2016;3(8):760–773. DOI: 10.1016/S2215-0366(16)00104-8

  2. Volkow ND, Koob GF, McLellan AT. Neurobiologic advances from the brain disease model of addiction. N Engl J Med. 2016;374(4):363–371. DOI: 10.1056/NEJMra1511480

  3. Goldstein RZ, Volkow ND. Dysfunction of the prefrontal cortex in addiction: neuroimaging findings and clinical implications. Nat Rev Neurosci. 2011;12(11):652–669. DOI: 10.1038/nrn3119

  4. Lelic D, Niazi IK, Holt K, et al. Manipulation of dysfunctional spinal joints affects sensorimotor integration in the prefrontal cortex: a brain source localization study. Neural Plasticity. 2016;2016:3704964. DOI: 10.1155/2016/3704964

  5. Haavik H, Niazi IK, Jochumsen M, et al. Impact of spinal manipulation on cortical drive to upper and lower limb muscles. Brain Sci. 2017;7(1):2. DOI: 10.3390/brainsci7010002

  6. Holt K, Niazi IK, Nedergaard RW, et al. The effects of a single session of chiropractic care on strength, cortical drive, and spinal excitability in stroke patients. Sci Rep. 2019;9:2673. DOI: 10.1038/s41598-019-39577-5

  7. Moon SJE, Schlenk EA, Lee H. Heart rate variability in adults with substance use disorder: a comprehensive narrative review. Biol Res Nurs. 2024;26(1). DOI: 10.1177/10783903221145142

  8. Eddie D, Wieman S, Pietrzak A, Zhai X. In natura heart rate variability predicts subsequent alcohol use in individuals in early recovery from alcohol use disorder. Addict Biol. 2023;28(8):e13306. DOI: 10.1111/adb.13306

  9. Eddie D, Nguyen M, Zeng K, Mei S, Emery N. Heart rate variability biofeedback for substance use disorder: a randomized clinical trial. JAMA Psychiatry. 2025;82(12):1177–1185. DOI: 10.1001/jamapsychiatry.2025.2700

  10. Zhang J, Dean D, Nosco D, Strathopulos D, Floros M. Effect of chiropractic care on heart rate variability and pain in a multisite clinical study. J Manipulative Physiol Ther. 2006;29(4):267–274. DOI: 10.1016/j.jmpt.2006.03.010

  11. Sampath KK, Tumilty S, Wooten L, et al. Effectiveness of spinal manipulation in influencing the autonomic nervous system: systematic review and meta-analysis. J Man Manip Ther. 2024;32(1):10–27. DOI: 10.1080/10669817.2023.2285196

  12. Sinha R. Chronic stress, drug use, and vulnerability to addiction. Ann N Y Acad Sci. 2008;1141:105–130. DOI: 10.1196/annals.1441.030

  13. Sinha R. Stress and substance use disorders: risk, relapse, and treatment outcomes. J Clin Invest. 2024;134(16):e172883. DOI: 10.1172/JCI172883

  14. Amjad I, Niazi IK, Kumari N, et al. The effects of 12 weeks of chiropractic spinal adjustments on physiological biomarkers in adults: a pragmatic randomized controlled trial. PLOS ONE. 2025;20(12):e0338730. DOI: 10.1371/journal.pone.0338730

  15. Hughes F. Reduction of cortisol levels and perceived anxiety in a patient undergoing chiropractic management for neck pain and headache: a case report and review of the literature. J Contemp Chiropr. 2020;3(1):14–20. journal.parker.edu

  16. Vernon HT, Dhami MS, Howley TP, Annett R. Spinal manipulation and beta-endorphin: a controlled study of the effect of a spinal manipulation on plasma beta-endorphin levels in normal males. J Manipulative Physiol Ther. 1986;9(2):115–123. PMID: 2942618

  17. Cui C, Shurtleff D, Harris RA. Neuroimmune mechanisms of alcohol and drug addiction. Int Rev Neurobiol. 2014;118:1–12. DOI: 10.1016/B978-0-12-801284-0.00001-4

  18. Li X, Ramos-Rolón AP, Kass G, et al. Imaging neuroinflammation in individuals with substance use disorders. J Clin Invest. 2024;134(11):e172884. DOI: 10.1172/JCI172884

  19. Teodorczyk-Injeyan JA, Injeyan HS, Ruegg R. Spinal manipulative therapy reduces inflammatory cytokines but not substance P production in normal subjects. J Manipulative Physiol Ther. 2006;29(1):14–21. DOI: 10.1016/j.jmpt.2005.10.002

  20. Teodorczyk-Injeyan JA, Triano JJ, Injeyan HS. Effects of spinal manipulative therapy on inflammatory mediators in patients with non-specific low back pain. Chiropr Man Therap. 2021;29:3. DOI: 10.1186/s12998-020-00357-y

  21. Naqvi NH, Rudrauf D, Damasio H, Bechara A. Damage to the insula disrupts addiction to cigarette smoking. Science. 2007;315(5811):531–534. DOI: 10.1126/science.1135926

  22. Menon V, Uddin LQ. Saliency, switching, attention and control: a network model of insula function. Brain Struct Funct. 2010;214(5–6):655–667. DOI: 10.1007/s00429-010-0268-7

  23. Miller M, Kiverstein J, Rietveld E. Embodying addiction: a predictive processing account. Brain Cogn. 2020;138:105495. DOI: 10.1016/j.bandc.2019.105495

  24. Corcoran KL, Bastian LA, Gunderson CG, et al. Association between chiropractic use and opioid receipt among patients with spinal pain: a systematic review and meta-analysis. Pain Med. 2020;21(2):e139–e145. DOI: 10.1093/pm/pnz219

  25. Trager RJ, Cupler ZA, Gliedt JA, et al. Association between spinal manipulative therapy for low back pain and opioid use disorder: a retrospective cohort study. Health Sci Rep. 2025;8:e71267. DOI: 10.1002/hsr2.71267

  26. Passmore S, Malone Q, Manansala C, et al. A retrospective analysis of pain changes and opioid use patterns temporally associated with a course of chiropractic care at a publicly funded inner-city facility. J Can Chiropr Assoc. 2022;66(2):107–117. PMCID: PMC9512299

  27. Holder JM, Duncan RC, Gissen M, Miller M, Blum K. Increasing retention rates among the chemically dependent in residential treatment: auriculotherapy and subluxation-based chiropractic care. Mol Psychiatry. 2001;6(Suppl 1):S8. nature.com

  28. Blum K, Braverman ER, Holder JM, et al. Reward deficiency syndrome: a biogenetic model for the diagnosis and treatment of impulsive, addictive, and compulsive behaviors. J Psychoactive Drugs. 2000;32(Suppl):1–112. DOI: 10.1080/02791072.2000.10736099

  29. Jung Y, Montel RA, Shen PH, Mash DC, Goldman D. Assessment of the association of D2 dopamine receptor gene and reported allele frequencies with alcohol use disorders: a systematic review and meta-analysis. JAMA Netw Open. 2019;2(11):e1914940. DOI: 10.1001/jamanetworkopen.2019.14940

  30. Hatoum AS, Colbert SMC, Johnson EC, et al. Multivariate genome-wide association meta-analysis of over 1 million subjects identifies loci underlying multiple substance use disorders. Nat Ment Health. 2023;1(3):210–223. DOI: 10.1038/s44220-023-00034-y

  31. Robison AJ, Nestler EJ. Transcriptional and epigenetic mechanisms of addiction. Nat Rev Neurosci. 2011;12(11):623–637. DOI: 10.1038/nrn3111

  32. Nestler EJ, Lüscher C. The molecular basis of drug addiction: linking epigenetic to synaptic and circuit mechanisms. Neuron. 2019;102(1):48–59. DOI: 10.1016/j.neuron.2019.01.016

  33. Tolomeo S, Yu R. Brain network dysfunctions in addiction: a meta-analysis of resting-state functional connectivity. Transl Psychiatry. 2022;12:41. DOI: 10.1038/s41398-022-01792-6

  34. Daligadu J, Haavik H, Yielder PC, Baarbe J, Murphy B. Alterations in cortical and cerebellar motor processing in subclinical neck pain patients following spinal manipulation. J Manipulative Physiol Ther. 2013;36(8):527–537. DOI: 10.1016/j.jmpt.2013.08.003

  35. Navid MS, Lelic D, Niazi IK, et al. The effects of chiropractic spinal manipulation on central processing of tonic pain. Sci Rep. 2019;9:6925. DOI: 10.1038/s41598-019-42984-3

bottom of page