Acupuncture for Addiction Treatment
Acupuncture is a system of healing developed over 3,000 years ago in China. It spread throughout the Far East and then, thanks to French Jesuit missionaries, to Europe. It came to America in the kits of Chinese immigrants, particularly Chinese railroad workers during the 19th century. What really launched acupuncture in the West, however, was a single column in the New York Times in the late 1970s written by an influential journalist named James Reston who was covering President Richard Nixon's historic visit to the People's Republic of China. After an unexpected emergency appendectomy, Reston was given acupuncture to reduce post-operative pain and described his medical adventure in his column. It inspired a rush of American medical doctors to China to investigate the technique.
During the forty years since Reston's post-op pain relief, acupuncture has been used to treat many different physical and emotional conditions in hospitals and private clinics around the world. According to the World Health Organization, over 40 different medical conditions are treatable by acupuncture, including drug addiction.
The word acupuncture comes from the Latin "acus" for needle and "puncture" for insertion. What the ancient Chinese discovered was a communication pathway through the body that could be intercepted and manipulated by careful choice of where and how one inserted needles.
Imagine your own home electrical circuit overloading from too many devices being plugged in at once. The lights go out in the bathroom. You walk to a far wall of the house, or even to an outside wall, to flip a breaker in the breaker box and the light turns on again. In humans and animals, acupuncture points are like those breaker switches. When the right points are stimulated the body gets what it needs to function correctly.
When a patient comes to an acupuncturist with pain, emotional distress, or a malfunctioning organ, the acupuncturist pays attention to many different sources of information. For a private patient, the acupuncturist feels the person's wrist pulse, looks at the person's tongue, eyes, skin color and texture, notes the quality of the voice and the details of the person's life history to make a diagnosis and form a treatment plan.
In a drug treatment setting, a dozen or more people might be scheduled for one hour to relax in chairs in the same room for their acupuncture. There isn't time to collect as much data as in a private office, and it isn't necessary. Inserting a few needles in specific sites in the ear immediately influences the patient's immune system, nervous system, cardiovascular system, and hormonal system. The body pays attention to new signals that are cumulative, so over time it is easier for the person receiving acupuncture to notice what at first was subtle but then becomes more evident: a sense of peace, inner control, and self-reflection that compliment and ideally precede the psychological work done with professional counselors.
Needles aren't always necessary. Intervention may occur through laser light, pressure from fingers, stimulation from magnets, or other methods.
In a drug treatment program, acupuncture with needles and pressure from fingers, plant seeds, magnets, and metal beads are used to improve the balance of brain chemicals, improve the function of the liver, kidneys, lungs, and other organs of detoxification, and move the client toward inner healing by using the energy of group process. One name often used to describe this work is "acudetox."
Traditional acupuncturists have treated addiction for many centuries. What is new is a movement to standardize the acudetox protocol to a simple formula of five points in the ear. This allows even non-acupuncturist technicians to be highly successful in improving program outcomes.
Acupuncture in Drug Court
During the mid-1980s, the jails in Miami and other Florida cities were crowded with cocaine users. One judge on the 11th Circuit Court was given a year off the bench to find a solution. Judge Herbert Klein was impressed with the group acupuncture program at Lincoln Hospital run by psychiatrist Michael Smith, MD. Soon Smith was helping Klein and others, including former US Attorney General Janet Reno, design the country's first Drug Court, which opened in Dade County, Florida, in 1989. In addition to acupuncture, the Drug Court included 12-Step meetings and counseling sessions as the carrot and time in jail as the stick to help nudge people into recovery.
Across the country in San Francisco, acupuncturist Pat Keenan remembered seeing Chinese doctors using surgical tape to stick plump black plant seeds called semen vaccariae on the ears of children in a clinic in Nanjing when she had studied there. The ear seeds were pressed as a form of acupressure to treat various ailments. Working in a public health clinic in a poor neighborhood, Pat decided to apply the same technique to drug-exposed babies. “The...semen viccariae were chosen because they are the right consistency and shape so they don't irritate the baby's skin,” wrote Pat in the clinic newsletter back in 1991. She chose three ear points commonly used in acupuncture: kidney, brain stem, and “shenmen,” a point used to increase endorphins. Babies, even rigid PCP-exposed infants, quickly responded, relaxing into quiet softness in her arms. Today, most acudetox programs include the application of seeds or magnetized metal beads on the surface of the ear, held in place with special tape that lasts for a week or two. Clients squeeze their own ears during the hours or days between acupuncture sessions.
How and Why Does It Work?
Whether with needle, seed, or magnet, what happens during acudetox is stimulation of a cranial nerve branch in the ear. In fact, some practitioners maintain that it isn't really “acupuncture” based on ancient Chinese theories of energy but rather “auriculotherapy” which is a more general term for treating the ear.
When needling, the five locations used are named Shenmen (Chinese for “spirit gate” and known to increase the body's natural supply of opiates called endorphins), Sympathetic (which relaxes the sympathetic nervous system), and Kidney, Liver, and Lung (the three major detox organs).
How do we know it works? It isn’t easy to research acupuncture using the standard placebo-controlled double-blind experimental model standard in Western studies, because how does one create a placebo acupuncture treatment with needles? And how does one “blind” the acupuncturist who is inserting the needles? So we don’t worry about placebo vs non-placebo, just acupuncture vs non-acupuncture.
In 1999, retrospective cohort study published in the Journal of Substance Abuse Treatment, Michael Shwartz of Boston University looked at detoxification readmission rates of clients treated in outpatient and short-term residential treatment for substance-abuse detoxification, some with acupuncture, some not. No matter how he looked at the data, acupuncture clients were less likely to be readmitted for detoxification within six months. (“The value of acupuncture detoxification programs in a substance abuse treatment system,” Shwartz, M, Saitz, R., Mulvey K., Brannigan, P. School of Management, Boston University, MA 02215, USA, J Subst Abuse Treat. Dec;17(4):305-312, 1999
According to the National Acupuncture Detoxification Association (NADA) Training Resource Manual, acudetox is useful for each specific drug of choice:
The NADA protocol can be integrated into a number of different methadone-assisted treatment programs. Patients report a decrease in secondary symptoms of methadone such as constipation, sweating, and sleep problems. Typically there is a substantial drop in requests for symptomatic medication. Treatment staff usually notices decreased hostility and increased compliance in acudetox recipients. The most important impact of acudetox in methadone programs is the reduction of secondary substance abuse, usually involving alcohol and cocaine, even in patients with minimal motivation (Margolin, 1993). Acudetox is effective with patients on any level of methadone, buprenorphine or other medication protocol.
Methadone withdrawal is notable for unpredictable variations in symptoms and significant post- withdrawal malaise. Acudetox helps clients to manage their fear and withdrawal symptoms and increase their ability to participate in the psycho-social supports necessary to recovery.
Alcohol withdrawal can be life-threatening. Directors of the acudetox assisted social setting detox program conducted by the Tulalip Tribe of Marysville, Washington estimate a yearly saving of $148,000 due to decreased referrals to hospital programs. Inpatient alcohol detoxification units typically combine acudetox and herbal Sleepmix tea with a tapering benzodiazepine protocol. Patients report few symptoms and better sleep. Their vital signs stabilize and they need less benzodiazepines. One residential program in Connecticut noted a 90% reduction in Valium demand when the herbal tea alone was added to their protocol.
Retention of alcohol detoxification clients generally increases by 50% when an acudetox component is added to conventional settings. Some alcoholics receiving acudetox report a resultant aversion to alcohol. Woodhull Hospital in Brooklyn reported that 94% of the patients in the acudetox receiving group remained abstinent as compared to 43% of the control group who received only conventional outpatient services. Bullock (1989) showed a 52% retention of alcoholic patients receiving true acudetox, as compared to a 2% “sham” acudetox retention rate.
Acudetox recipients report more calmness and reduced craving for cocaine even after the first treatment. The acute psychological indications of cocaine toxicity are visibly reduced during the treatment session. The improvement is sustained for a variable length of time after the first acudetox treatment. After 3-7 sequential treatments, the anti-craving effect is more-or-less continuous with ongoing regular acudetox.
A study of cocaine-dependent methadone maintained patients receiving 8 weeks of acudetox found a 44% overall abstinence rate. Abstainers reported decreased depression, a shift in self- definition, decreased craving and increased aversion to cocaine-related cues (Margolin, 1993).
Urinalysis results at Lincoln Recovery Center for 226 cocaine and crack addicted persons who had received more than 20 acudetox treatments found that 149 had more than 80% negative urine screen tests for their entire treatment involvement and 39 more had at least 80% clean urine results for the two weeks prior to data collection.
Acudetox can lead to dramatic increases in treatment retention for cocaine addicted clients. A program for pregnant, crack-using women in NYC, Women in Need, reported the following:
an average of 3 visits for conventional outpatient treatment only
an average of 27 visits/year for acudetox along with conventional treatment
an average of 67 visits per year for those who received acudetox, conventional treatment and an educational component.
The NADA protocol affords a similar dramatic increase in retention for methamphetamine addicted persons. Hooper Foundation, a public detoxification program in Portland, OR, reported 5% retention of methamphetamine users prior to the use of acudetox, and 90% retention after the addition of acudetox. The program noted increased psychological stability and decreased craving.
Primary marijuana addicted persons usually report a rapid reduction in craving and an improved sense of mental well-being from acudetox. Secondary marijuana use is usually eliminated along with the detoxification of the primary drug, e.g., cocaine.
(NADA Training Resource Manual, p. 64-66, www.acudetox.com)
In some locations non-acupuncturists such as social workers, nurses, corrections officers, and case workers can learn to insert needles and, after a 70-hour training, can work as an Acupuncture Detoxification Specialist. Since these professionals are often already on staff, the cost of acupuncture within a community or private care facility can be radically reduced.
Various states have varying degrees of leniency in who can become an ADS. In a few you must be a registered nurse. In others you can be any person working in the field of addiction treatment. You can find details for each state here https://www.acudetox.com/how-do-state-laws-differ on the National Acupuncture Detoxification Association (NADA) website.
For information about becoming an ADS, contact NADA at www.acudetox.com.
Non-Acupuncturist Detox Specialists
Scientific Studies-Auricular Acupuncture
The National Acupuncture Detoxification Association protocol, auricular acupuncture to support patients with substance and behavioral health disorders: current perspectives, Elizabeth B. Stuyt and Claudia A Voyles. Journal of Substance Abuse and Rehabilitation 2016; 7. 169-180
NADA Ear Acupuncture: An Adjunctive Therapy to Improve and Maintain Positive Outcomes in Substance Abuse Treatment. Carter K1, Olshan-Perlmutter M2, et al. Behav Sci (Basel). 2017 Jun 16;7(2). pii: E37
Establishing an animal model for National Acupuncture Detoxification Association (NADA) auricular acupuncture protocol. Kattalai Kailasam V1, Anand P2, Melyan Z3. Neurosci Lett. 2016 Jun 15;624:29-33. j.neulet.2016.05.001. Epub 2016 May 4.
NADA protocol: integrative acupuncture in addictions.
Braverman, E.R., and Blum, K., et al. “Increasing retention rates among the chemically dependent in residential treatment: auriculotherapy and subluxation-based chiropractic care.” Molecular Psychiatry, 6(S8), 2001.
Reuben, C. et al. “Acupuncture & Auriculartherapy: Valuable natural treatment modalities for treatment for addiction.” Townsend Letters 269:81-84.
Shwartz, M., Saitz, R., Mulvey, K., and Brannigan P. “The value of acupuncture detoxification programs in a substance abuse treatment system.”Journal of Substance Abuse Treatment. Dec:17(4): 305-312, 1999.
Published by Bureau of Justice Assistance, May 24, 2011
Books on Acupuncture for Detoxification and Recovery
Fighting Drug Abuse with Acupuncture: The Treatment That Works. Ellinor R. Mitchell, Pacific View Press, 1995. Mitchell took the time to interview the key players in acudetox and tell their story.
Transformation & Recovery: A Guide for the Design and Development of Acupuncture-Based Chemical Dependency Treatment Programs. Alex G. Brumbaugh, Stillpoint Press, 1994. Still the bible of acudetox, covering everything from the practicalities of opening an acupuncture treatment program to the spiritual dimensions of addiction work.