Overview

Addiction & Acupuncture

Acupuncture is currently used in the treatment of addiction by approximately 600 substance abuse programs. Clinical evidence supports that it is effective in ameliorating withdrawal and craving symptoms associated with alcohol, opiate, and cocaine dependence, as well as symptoms associated with other commonly abused substances. Acupuncture for cocaine dependence has been particularly recognized as an important innovation, since there are presently no established pharmaceutical treatments for cocaine dependence. Programs use acupuncture as a foundation for later psychosocial recovery. It is a nonverbal, non-threatening, 'first step' intervention that has an immediate calming effect on patients. Initial participation with acupuncture has been found to improve patient's overall treatment retention and to facilitate their subsequent involvement. In most programs patients receive 4-5 ear acupuncture points while seated in a large group room so that a substantial number of patients can be treated conveniently. This safe and cost efficient procedure has gained increasing acceptance from agencies responsible for overseeing substance abuse treatment. This chapter will evaluate the efficacy of acupuncture in addiction treatment through analysing the research findings. Mechanisms of action. Which involve physiology and psychosocial process, will be covered.

Acupuncture treatment for drug and alcohol problems was primarily developed at Lincoln Hospital USA; a city facility in the impoverished South Bronx. The Substance Abuse Division at Lincoln is a State licensed treatment program, which has provided more than 500,000 acupuncture treatments in the past 20 years (Omura 1975). Dr Yoshiaki Omura was the consultant who began the program, initially, in 1974; Lincoln using Dr H. L. Wen's (1973) method, applying electrical stimulation to the lung point in the ear. Lincoln was a methadone detoxification program at that time; therefore, acupuncture was used as an adjunctive treatment for prolonged withdrawal symptoms after the 10-day detoxification cycle. Patients reported less malaise and better relaxation in symptom surveys. Subsequently twice-daily acupuncture was used concurrently with taping methadone doses. Reduction in opiate withdrawal symptoms and prolonged retention was noted.

It was accidentally discovered that electrical stimulation was not necessary to produce symptomatic relief. In fact, simple manual needling produced a more prolonged effect. Patients were able to use acupuncture one time a day and still experience a suppression of their withdrawal symptoms. A reduction in craving for alcohol and heroin was described for the first time. This observation corresponds to the general rule in acupuncture that strong stimulation has primarily symptom suppression or 'sedation' effect and that more gentle stimulation have more of a long term preventive or 'tonification' effect.

Gradually the acupuncture protocol was expanded by adding the 'shen men' (spirit gate), a point which is well known for producing relaxation, other ear points were tried on the basis of lower resistance, pain sensitivity, and clinical indication during a several year developmental process. Dr Michael Smith of Lincoln Hospital added that 'sympathetic', 'kidney' and 'liver' points to create a basic five-point formula. Numerous other point formulas using body acupuncture points were tried on an individual basis without any significant improvement.

Bensky (1985) describes the functions of each of the five points in basic formula;

• Sympathetic - used for numerous diseases related to disruption in both sympathetic and parasympathetic nervous systems. Strong analgesic and relaxant effect upon internal organs. Dilated blood vessels.
• Shenmen - regulates excitation and inhibition of cerebral cortex. Sedative and anti-allergy effects. Used for many neuropsychiatry disorders.
• Lung - used for analgesia, sweating and various respiratory conditions.
• Liver - Used for hepatitis, anemia, neuralgia, muscle spasms, and eye diseases.
• Kidney - conditions - strenghing points for the cerebrum, haematopoietic system and kidneys. Used for neurasthenia, lassitude, headache, and urogenital problems.

Traditional Chinese theory associates the lung with the grieving process; the liver with resolving aggression; and the kidney with will power and rebirth.

The value of using one standard group of acupuncture points became increasingly clear. The standard formula seems to be equally effective for different drugs of abuse and at different stages of treatment. Patients respond better when acupuncture treatment was administered quickly without a self-conscious, diagnostic prelude. Since acupuncture produces a homeostatic response. It was not necessary to adjust the formula for mood swings, agitation, or energy.

From the point of view of Chinese theory, using a single basic formula for such generally depleted patients is appropriate. In TCM, the lack of a calm inner tone in a person is described as a condition of 'empty fire' (xu huo), because the heat of aggressiveness burns out of control when the calm inner tone is lost. It is easy to be confused by the 'empty fire' that many addicts exhibit and to conclude that the main goal should be the sedation of excess fire. Addicts themselves take this approach in the extreme to be using sedative drugs. The 'empty fire' condition represents the illusion of power, an illusion that leads to more desperate chemical abuse and senseless violence.

Acupuncture detoxification program reports substantial reduction in their recidivism rates. The Hooper Foundation in Portland USA cited decease from 25% to 6% in comparison to the previous non-acupuncture year. Kent-Sussex (Delaware) reported decease in recidivism from 87% to 18%. Substance Abuse Recovery in Flint, noted that 83% of 100 General Motors employees were drug and alcohol free productive workers a year after prior attempts at treatment and frequent relapses. The entire 17% failure group had less than 5 program visits, 74% of the successes group continued to attend. Alcohol Anonymous and Narcotic Anonymous meeting after completing the treatment program (Smith / Khan 1989).

Programs specifically designed for adolescents, such as the Alcohol Treatment Centre in Chicago and Job Corps related program in Brooklyn USA, have shown retention rates comparable to adult programs.

The treatment of addiction is, as far as the literature suggests, and area in which acupuncture can be used to good effect in conjunction with other therapies. Dale (1993) in a recent review, has demonstrated convincingly that acupuncture is highly effective in the treatment of addiction to alcohol, drugs, (including heroin, cocaine and crack), and tobacco. Eating disorders including bulimia, anorexia, nervosa and sugar cravings, may also be resolved. The used of auricular therapy and electroacupuncture are shown to release cravings, facilitate detoxification, relieve anxiety, improve sensory function and concentration and support the immune system. However, acupuncture should not, he says, be seen as a pancreas, and is used most effectively for addiction when combine with other therapies including herbs homeopathy, counselling and psychotherapy.

The World Health Organization, as far back as 1979, also suggested that acupuncture could be effective. The WHO listed 40 major diseases that could find relief by acupuncture treatment; this included the problem of addiction.