An acupuncture programme for the treatment of drug-addicted persons
Mechanism of action
Limitations of acupuncture detoxification
Current programme of the National Acupuncture Detoxification Association
Training provided in local settings
Relevance to developing countries
Future development of training programmes
Author: M. O. SMITH , I. KHAN
Pages: 35 to 41
Creation Date: 1988/01/01
I. KHAN Senior Medical Officer, Division of Mental Health, World Health Organization, Geneva, Switzerland
Over the past 13 years, Lincoln Hospital, New York City, has used acupuncture as the primary method of treatment for drug-addicted persons. The programme receives, on a daily out-patient basis, 200 drug-addicted persons for detoxification. Acupuncture relieves withdrawal symptoms, prevents the craving for drugs and increases the rate of participation of patients in long-term treatment programmes. The best results have been obtained by treating patients in an open-group setting, using acupuncture points in the external ear with needles without electrical stimulation. The same points are used at each visit, regardless of the type of drug to which the person is addicted. This method is also used for the treatment of persons suffering from stress.
The National Acupuncture Detoxification Association (NADA) has conducted successful training programmes for physicians and related staff in using the technique and philosophy of traditional Chinese acupuncture. These training programmes usually include courses in counselling skills, ethical responsibilities and sterilization procedures that are appropriate to local conditions.
NADA has begun to operate a pilot programme to treat approximately 1,000 drug abusers and people who are under a high level of stress, which may lead them to the abuse of drugs. It is assumed that acupuncture, in conjunction with other drug-demand reduction programmes, can make a significant impact on the illicit demand for drugs by reaching this entire range of patients.
Acupuncture has become a well-established method of therapy for various health disorders. It has an ancient tradition in Asian medicine and has been increasingly used by Western medicine over the past two decades. The World Health Organization (WHO) has published a list of health disorders for which acupuncture has been found to be helpful. The safety and convenience of acupuncture also make it an attractive method of treatment for drug-addicted persons.
The magnitude and diversity of drug abuse problems have outweighed current health care resources to cope with them. Various methods are currently used for the treatment of drug-dependent persons, but the acceptability and reported usefulness of these methods vary from one society to another. It is desirable to use a treatment method that is both effective and applicable at low cost. In order to meet this requirement and to help attain the objective of the WHO long-term programme to provide health care to all by the year 2000, different methods of treatment must be explored. In this respect, acupuncture offers an option for the treatment of drug-dependent persons, and this article summarizes experience gained so far in a programme established by Lincoln Hospital, New York City, United States of America.
Over the past 13 years, Lincoln Hospital has used acupuncture as the primary method for treating drug-addicted persons. It is a city-owned hospital located in the South Bronx, which is mainly populated by lower-income people. The acupuncture programme for drug addicts receives on an out-patient basis 200 addicted persons daily for detoxification, At Lincoln Hospital, 40 per cent of new patients dependent on crack give a series of clean urine tests several weeks after treatment. Acupuncture greatly increases the rate of participation of drug addicts in long-term treatment programmes.
It has been observed that acupuncture facilitates other treatment programmes and has been adopted by methadone and drug-free programmes alike. The results obtained in research carried out at the University of Minnesota and the Downstate Medical Center in the United States have confirmed that acupuncture substantially reduces withdrawal symptoms and the craving for drugs [ 1,2] . The study of acupuncture treatment for alcoholics conducted during 1984 and 1985 by Hennepin County Hospital in Minnesota was particularly impressive with its clear-cut positive results. It used a placebo protocol. Positive results have been obtained using acupuncture detoxification of patients dependent on cocaine, opiates, phencyclidine or alcohol.
Drug addicts are impressed by the fact that daily acupuncture can relieve withdrawal symptoms as reliably as the drugs they use. They also discover that acupuncture can prevent drug craving even if none of their personal problems are resolved- Nevertheless, it is very important to integrate the acupuncture treatment into counselling and other psycho-social services provided for drug-dependent persons.
Acupuncture detoxification is a very convenient treatment modality for a patient. The actual process of acupuncture takes several minutes per patient. It has been learned that for each patient the same set of acupuncture points should be used at each visit, regardless of the type of drug that has been abused. The best acupuncture results are obtained when patients receive treatment in an open-group setting, in which they are able to relax easily. Some women hold their small babies in their laps during treatment. Children usually remain calm in this type of setting, and no one is distracted. New patients are able to observe the treatment process so that they do not fear the pain of needle insertion.
Addicted persons are attracted by the opportunity to reduce their inner turmoil. It has been described elsewhere [ 3] that violent and paranoid drug abusers have been substantially helped by the Lincoln Hospital acupuncture programme. Acupuncture detoxification is a non-judgemental, nurturing process. It blends well with most crisis counselling and long-term rehabilitation programmes. The method of acupuncture used for the treatment of drug-dependent persons is also appropriate for the treatment of persons suffering from stress.
The mechanism of action of acupuncture has not been fully understood in physiological terms, but it probably involves the homeostatic actions of the autonomic nervous system, various neurotransmitters, and elements in the pituitary-subcortical axis. For the purpose of this article, it is important to focus on the following functions of acupuncture that have been observed:
Relief of withdrawal symptoms and craving;
General relaxation and homeostatis;
Apparent enhancement of mental and physical functioning by activating the reserve capabilities of the body.
In traditional Chinese medicine, 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 xu huo that many addicts exhibit and to conclude that the main goal should be the sedation of excess fire. In fact, addicts themselves take this approach in the extreme by using sedative drugs. The xu huo condition represents the illusion of power, an illusion that leads to more desperate chemical abuse and senseless violence. Acupuncture helps patients with this condition to restore their inner control.
It has been observed that the use of acupuncture points located in the external part of the ear gives the best results in the treatment of drug-dependent persons. The following points are used: "sympathetic", ' shen men', "kidney", "liver" and "lung". At Lincoln Hospital, no electrical apparatus is used. In the 1970s, several acupuncture programmes applied the electro-acupuncture method for the treatment of drug-dependent persons, but it was observed that this method was short-acting and had to be used in an in-patient setting. It was also observed that electro-acupuncture was not sufficiently flexible and inexpensive to be widely used.
There is a risk of infection if the acupuncture needles are not cleaned and sterilized properly. At present, this risk is compounded by the spread of the human immunodeficiency virus (HIV), which causes acquired immunodeficiency syndrome (AIDS). At Lincoln Hospital, a double autoclave procedure for sterilization is used so that the technician preparing the needles is protected from an accidental puncture. As an extra precaution, needles from patients with diagnosis of AIDS are destroyed after use.
Another difficulty in this field is an unfamiliarity with the use of acupuncture in the treatment of drug dependence. The procedure is nearly painless and causes the rapid onset of a gratifying sense of relaxation, but, on first exposure, most patients express fear of the pain of needle insertion and are confused by the idea that little needles can cope with their big problems. ,Isis fear is easily solved by letting prospective patients observe the actual process of treatment. It would be a mistake to rely only on leaflets and verbal explanations.
After acupuncture detoxification, patients should be provided with counselling, social support and measures for social reintegration.
The National Acupuncture Detoxification Association (NADA) was formed in 1985 to support the use of acupuncture in the treatment of drug-dependent persons in various clinical and socio-cultural settings. Successful acupuncture components have been included in conventional programmes for the reduction of drug abuse in a number of countries.
NADA has helped the Los Angeles Sheriff's Department to set up a programme as a potential alternative to imprisonment. The programme is designed to use acupuncture as the primary means of detoxification in the county jail and to treat up to 500 drug-addicted persons daily in this large facility.
NADA has conducted successful training programmes in social settings with different cultural and economic backgrounds. It has trained physicians and related staff in using the technique and philosophy of acupuncture. Senior NADA consultants are licensed in traditional Chinese acupuncture. They also have recognized professional degrees for substance abuse treatment. Several have considerable international experience and multilingual skills necessary for cross-cultural co-operation in technical assistance programmes. The promotion of cross-cultural expertise in this field requires learning traditional Chinese medicine and translating it into a concrete drug abuse treatment programme- NADA has accomplished this goal in a clinic, which has received little financial support, particularly in terms of research funding. Training is conducted either in a community or hospital setting.
NADA issues certificates for trainees who successfully complete a required programme. In addition to technical training in acupuncture, this programme usually includes training in counselling skills and ethical responsibilities. Teaching the oriental philosophy of balance and internal development is an essential part of training. NADA consultants understand the necessity of developing supply and sterilization procedures that are appropriate to local conditions.
The training programme of NADA is of shorter duration than most other acupuncture training programmes, which usually have long traditional curricula. While such curricula are important for the treatment of various health disorders, they have little relevance to the use of acupuncture for treatment of drug-addicted persons. Numerous training programmes for physicians provide short courses in the use of electro-acupuncture, but the authors of this article have observed that the use of electro-acupuncture for the treatment of drug-dependent persons is not as effective as the traditional use of needles and point locations.
NADA has set up acupuncture components in two native American programmes on alcoholism. Each of these programmes has been able to provide 20 acupuncture treatments daily after the training has been completed. Ear acupuncture is used as a technique. In spite of the high rate of alcoholism among native Americans, these programmes had previously applied methods of detoxification, which were expensive and culturally less acceptable. Although native Americans have a coherent set of cultural values that can form the basis of long-term rehabilitation, the two programmes lacked a method of reaching members of the tribe who were actively involved in drinking. Acupuncture helped them to overcome this problem, and in one week the number of patients in the programmes showed a 10-fold increase. Many more patients were able to achieve advanced levels of rehabilitation, because the use of acupuncture had laid a more solid foundation for long-term recovery.
The chairperson of NADA gave a workshop in October 1985 at Szeged, Hungary, at the large alcoholism hospital, Nagyfa, which is administered by the Hungarian police. The physicians there had only a minimum understanding of acupuncture prior to the workshop; after intensive training, they were able to establish an acupuncture programme, which subsequently reported beneficial results in 60 per cent of alcoholics treated with acupuncture [ 4] .
In December 1986, a NADA specialist conducted a two-week acupuncture training programme for staff of the local drug abuse prevention and treatment programme, St. Xavier's, operated by the Jesuit order at Kathmandu, Nepal. From 6 to 10 drug-dependent persons were treated each day during the training programme, and, during the second week of training, the NADA trainer was able to observe that the trainees performed treatments correctly and used appropriate sterile precautions. A videotape and slides were made of the training sessions. Following the acupuncture training, the local drug abuse programme developed an extensive support network among nearby Nepalese families, while previously it had not been able to use any method of detoxification of drug addicts that was acceptable to patients and suitable to their indigenous cultural setting. Of the first 60 patients treated at St. Xavier's Service Center, 40 per cent have shown clear improvement, according to the Director of the Center.
The illicit demand for drugs, which is at present an immense problem, has become even more critical with the recent increasing spread of HIV causing AIDS. Encouraged by the Health Department of San Francisco, NADA has begun to operate a pilot programme designed to attempt to cope with the problem. The goal of this programme is to treat both active and intermittent abusers, as well as people who are under a high level of stress, which may lead to drug abuse. It is assumed that acupuncture in conjunction with other drug demand reduction programmes, by reaching this entire range of patients, can make a significant impact on the illicit demand for drugs. The programme is projected to treat approximately l,000 people - per day. The basic ear acupuncture protocol developed by NADA has been shown to be effective for a diverse range of patients. NADA has carried out a stress relief programme for the staff of a large city agency, as well as for labour organizations. More than 50 persons were treated per hour, and all sessions were well-accepted. Using the example of Lincoln Hospital, it is possible to operate programmes that can treat 500 persons daily.
The advantages of acupuncture detoxification have particular significance for developing countries. The acupuncture protocol developed by NADA is simple to apply at low cost. It has been well-accepted by Latin American immigrants, rural native Americans and urban black people in the United States. None of these groups had any prior experience with acupuncture. In addition, it is well-known that acupuncture is traditionally popular in China, East Asia and parts of South-East Asia.
Acupuncture does not require special equipment or special testing procedures. Acupuncture needles can be easily sterilized in a steam autoclave or by other procedures. An acupuncture detoxification clinic can be set up in a matter of minutes in any location where people can sit comfortably. Training programmes have been conducted successfully in a variety of simple treatment settings.
NADA is prepared to offer training programmes in any part of the world. The acupuncture training has been most effectively conducted at the site of an on-going programme for the prevention and reduction of drug abuse. In such a setting, classroom discussions lead directly to the mastery of skills on a practical, clinical basis. Furthermore, it is essential to combine acupuncture with social support measures, rehabilitation and social reintegration, This too can be done most effectively in a setting of an on-going programme, although an acupuncture detoxification training programme should not be limited only to staff of an on-going programme.
l. M. Bullock and others, "Acupuncture treatment of alcohol recidivism: a pilot study", Alcoholism: Clinical and Experimental Research , vol. 11, No. 3 (1987), pp. 292-295.02
B. Bihari, unpublished results, 1985.03
M. O. Smith and R. Khunat, "Acupuncture in the treatment of chemical dependency and violence", paper presented at the Caribbean Mental Health Conference, 22-26 July 1985, Nassau, the Bahamas.04
L. Banka, personal communication on acupuncture treatment of alcoholics at Nagyfa Hospital, Budapest, Hungary, 1986.