The acupuncture treatment of alcohol and chemical dependency

JOURNAL OF CHINESE MEDICINE NUMBER 45 MAY 1994
The Acupuncture Treatment of
ALCOHOL AND CHEMICAL
by David Blow Dip.App.Sc. (Acup.)
We are still a long way from being able to say thousands of patients that experience relief of acute that acupuncture and the treatment of chemi- withdrawal symptoms, find their will power is strength- cal dependency is revolutionising North ened, and return regularly for treatment.
American medical history, but it is certainly demonstrat- A long-term addict or alcoholic is always recognisable ing, both across America and in the rest of the world, the by the ‘burnt-out' look on their faces. The depletion of therapeutic effectiveness and cost efficiency of a seem- their Jing-Essence revealed by this premature ageing ingly simple procedure.
needs to be tonified to assist recovery. Continued use of Michael 0. Smith could not have imagined, 20 years drugs and alcohol damages the Jing and Yin, causing a ago, that his hospital clinic in the Bronx area of New York pattern of Yin-Xu with empty heat. This creates a self- - filled with aggressive, anxious and street-beaten pa- generating cycle where the empty heat gives rise to tients - would be transformed into the calm and tranquil cravings for heroin and cocaine (and often any sub- atmosphere of the present-day busy outpatient clinic.
stance, as most users are polyabusers), aggression, nerv- The Bronx, in fact, seems the obvious location to treat ousness and illusions of power. These factors further drug and alcohol addiction, being the hottest spot in a debilitate Yin. This clinical picture of empty heat is high crime, high infant mortality and poverty afflicted recognised by TCM but misinterpreted by society in New York city.
general as a form of excess requiring sedation in the form Michael Smith and Richard Taft, who were already of methadone, anabuse treatment, social isolation or running a methadone treatment program at Lincoln even imprisonment.
Hospital, Bronx, realised the limitations of such a drug- An addict or alcoholic will present with a chronic based therapy for heroin addiction. An article1 by H. L.
pattern of Kidney and Liver Yin Xu as well as patterns of Wen on the treatment of heroin withdrawal symptoms Qi and Yang Xu. It is the Kidney Yin Xu, however, which by acupuncture, gave them the incen- continues the addiction cycle. This tive to look to TCM for the solution to chronic deficiency of nutritive Yin de- Acupuncture forms the basis
the shortcomings of their treatment. In velops after years of poor nutrition of the Acudetox program, but
the early 1970's, H. L. Wen used ear and poor living standards, often with acupuncture with electrical stimula- loses a lot of its effectiveness
educational under nourishment and a tion, along with methadone, for treat- when used without Western
disruptive family history. The Lincoln ing symptoms of acute heroin with- counselling techniques, AA
Clinic uses a five point ear treatment drawal. He had found, initially by ac- which tonifies Yin and moves Qi while and NA 12-step programs,
cident, that when he used ear acu- calming the Shen - giving both physi- puncture on heroin addicts for anaes- urine toxicology testing etc.
ological and psychological support to thesia during treatment for knife chest It is not recommended that
the patient.
wounds, many of the acute withdrawal acupuncture be used in isola-
The acute withdrawal symptoms are symptoms lessened. These results he treated with this protocol. These in- tion and it is for this reason
was able to duplicate in other patients.
clude: runny nose, irritability, insom- that the specific ear points
Since 1974 the Lincoln Clinic has been nia, loss of appetite, tachycardia, anxi- a unique working model for the cur- used in the program are not
ety, cravings, headaches, nausea, vom- rent 400 acupuncture detoxification included in this article.
iting, body aches, spontaneous sweat- programs in the United States and the ing, strong body odour, high blood rest of the world. The treatment protocol (Acudetox) pressure, rapid pulse, being easily startled, and dilated depends not only on acupuncture treatment, but also on pupils. The more psychological symptoms seen in the the comprehension of addiction from both a TCM and a post-acute withdrawal stage may be treated by the same modern counselling perspective. Treatment by ear acu- protocol. These include: anxiety, periodic agitation, fear puncture, however, cannot be seen as a symptomatic and paranoia, lethargy, reduced response to stress, in- treatment only. Its effectiveness in tonifying the Yin to somnia, reduced libido, poor digestion and pains of the counteract the false heat symptoms (which were initially knees and bones.
misinterpreted as excess symptoms needing to be elimi- Patients at every stage of recovery are treated in the nated by electrical stimulation), is demonstrated by the same way in a group setting so as to continue the JOURNAL OF CHINESE MEDICINE NUMBER 45 MAY 1994
supportive treatment process. Acudetox is not intended to contradict the TCM principles of individualised treat- Acupuncture helps patients quickly reach a state of ment based on pattern differentiation, but to reinforce mental and physiological equilibrium, thereby being treatment management of chronic abusers in a context better able to interact with other modalities used in the where not only the actual treatment (acupuncture), but treatment of chemical dependence. It loses a lot of its also the setting it is given in, helps tonify Yin whilst effectiveness when used in isolation from Western coun- eliminating empty heat.
selling techniques, AA and NA 12 step programs and As the patient works through the detoxification proc- urine toxicology testing. This acupuncture treatment ess, and withdrawal symptoms are reduced, ear acu- protocol is seen to complement these other therapeutic puncture alone as a treatment method becomes less forms. People working in this field often burn them- effective. When the patient moves out of the addiction selves out trying to use counselling methods alone to cycle, conventional acupuncture and herbs play a more overcome chronic cravings and insomnia. Withdrawal significant role in regaining homeostasis. Addicted pa- symptoms reflect a body imbalance as well a psycho- tients, however, first require stabilisation through the social imbalance. The soothing and anxiety relieving ear acupuncture protocol prior to being able to respond effects of acupuncture treatment nurture self control and to social, psychological and full TCM interventions. At behaviour modification and the patient is able to experi- this stage, patients become interested in keeping the ence immediate substantial relief from acute withdrawal rehabilitation process moving.
Psychology is perhaps the only branch of Western The effectiveness of acupuncture treatment is often medicine that is able to see the person as a whole, aware difficult, if not impossible, to verify using classical re- of the relationship between cause and effect, emotional search standards i.e. double blind testing, placebo stud- and physiological balance, which is primary to diagno- ies etc. The Lincoln Hospital, treating large numbers of sis and treatment by TCM. The development therefore of patients daily, used a survey analysis3 to report the these 400 Acudetox programs is rooted in the interrela- following results: tionship of these two medical systems.
• 90% of acute withdrawal symptoms are relieved.
Resistance from the medical community to the efficacy • 90% of patients returned to continue acupuncture of acupuncture continues, despite research on pain and treatment without financial or medical (methadone, tran- the acupuncture-stimulated production of endogenous quillisers etc.) incentives.
opiates (beta-endorphins). Widespread research data • 60% of patients remained drug and alcohol free after a shows the connection between acupuncture and alpha- period of several months.
and beta- endorphins, leu- and met- enkephalins, One of the largest placebo controlled studies on the dynorphin A and B, substance P, serotonine, epinephrine, efficacy of acupuncture on alcohol detoxification was noradrenalin, dopamine, acetylcholine, adreno- conducted in 19894 and was subsequently published in corticotrophic hormone (ACTH), glycine, glutamic acid, The Lancet. These researchers at the University of Min- the prostaglandins and cyclic AMP and GMP2. Even nesota designed a single blind random assessment study though the ‘mystery' remains of how acupuncture works comparing real acupuncture detoxification points (as in medical-scientific terms, the benefits of acupuncture outlined by the Lincoln Clinic) and false points. Treat- detoxification is making inroads into the acceptance of ment of the 80 recidivist alcoholic male patients was the TCM medical model by American, English, Saudi divided into 3 phases: Phase 1 - treatment once a day, 5 Arabian and Hungarian health funding agencies and days a week for 2 weeks; Phase 2 - treatment 3 times a legal systems.
week for 4 weeks; Phase 3 - treatment twice a week for 2 The Acudetox program used at Lincoln Hospital to weeks. 21 (52.5%) of the 40 patients in the treatment treat 250 patients a day, is extremely simple in that it does group completed all 3 phases, while only 1 (2.5%) of the not require differential diagnostic analysis of signs and 40 control patients did so. Only 3 (7.5%) of the treatment symptoms nor does it depend on which substance of patients left during Phase 1 compared to 19 (47.5%) of the abuse is used. Persons dependant on alcohol, heroin, control patients. At a six month follow-up, 6 of the 21 sedatives, methadone, stimulants, cocaine, crack and treatment patients who had finished all 3 Phases re- psychotropic drugs are all treated in the same way, at the ported no alcohol consumption compared to 1 of the same time, without delays, lengthy waiting lists or in- control, and none of the patients who did not finish all 3 timidating questions. This is the very reason for its Phases. Readmission to detoxification centers was also success. TCM therapy and approach is adapted for the markedly different between the 2 groups. The effective- condition it is treating - a deep social problem which ness of acupuncture for this chronic therapy-weathered finds ready relief through acupuncture performed in a group of patients is seen as a valuable tool especially group context, in a large room, devoid of music and when compared to costly in-patient detoxification.
other artificial relaxants; a room with as many as 40 or Relapse is a common phenomenon among drug and more people, who are using the most addictive stimu- alcohol treatment patients. Often, patients do not return lants available, seated comfortably, all having treatment to continue or to restart treatment as they feel guilty or at the same time in silence. Nearly meditative without fear being judged as failures. Acupuncture treatment being intentionally so - an atmosphere which is the overcomes this initial resistance to re-enter treatment, as natural consequence of the balancing effect of acupunc- a patient will sit and have acupuncture first rather than ture combined with the dynamics of a group situation.
have to clarify the reasons for the relapse. Patients will This results in a considerably greater therapeutic effect often volunteer the reasons for the relapse after the than the same treatment performed in an individual soothing effects of acupuncture are felt. In the otherwise JOURNAL OF CHINESE MEDICINE NUMBER 45 MAY 1994
non-treatable protracted abstinence syndrome, post- detoxification program, that since opening in July 1991, acute withdrawal symptoms may be effectively treated, admissions have been reduced by 50%. Acupuncture providing continuing support for the patient. Patients was performed in in-patient/out-patient settings in 3 are seen to return after months or even years into recov- different hospitals in this very socially controlled Arabic ery for a "tune up".
In a study at Yale University of Medicine5 the effective- The Gateway Clinic (London, England), started sev- ness of acupuncture, using the Acudetox protocol, was eral years ago, is a public out-patient clinic (totally tested on 32 cocaine dependent methadone maintained funded by the National Health System) that treats en- patients. Abuse of alcohol, cocaine and other substances tirely by TCM acupuncture and herbs. Staffed and di- is often encountered in methadone maintenance pro- rected by TCM trained personnel, this clinic treats 120 grams, which contraverts the fundamental goal of such patients daily suffering from drug and alcohol abuse, programs, i.e. cessation of drug use. Statistical analysis AIDS, HIV+ and AIDS related complex (ARC).
of the 32 patients showed that they Phoenix House, also in Lon- had been using cocaine for an av- don, is a residential drug and the Sioux called acupuncture "takus
erage of 13.41+/- 7.7 years and alcohol rehabilitation commu- kanskah" in the Lakota language,
using opiates for an average of nity, one of many that combine meaning "the mysterious power that
15.6 +/- 8.0 years. Treatment was traditional therapeutic counsel- given over a period of 8 weeks moves or flows through life"
ling with an acupuncture detoxi- where 5 treatments were given a fication program. Marked reduc- week for 6 weeks, and 3 treatments a week for the last 2 tion in violence and other symptoms related to acute weeks. Urine toxicology screenings were taken 3 times a withdrawal were seen after the implementation of acu- week to determine cocaine use. 14 of the 16 (88%) who puncture. The now more responsive patients remain for completed treatment obtained abstinence, and at a 6 continued therapy - 80% retention since acupuncture month follow-up, 10 patients (62.5%) had continued was used, compared to 33% previously9.
their abstinence from cocaine. The study also reported, Acupuncture detoxification in Hungary, since being through the application of Beck Depression Scores, a introduced in 1985, is being heralded as a major tech- substantial shift away from self representation as "ad- nique for its 2 million alcoholics. With an overall popu- dict" to "non-addict".
lation of 10 million, government health services are keen The lack of emphasis placed on mood modification by to implement effective, cost efficient detoxification serv- traditional drug and alcohol treatments ignores the very ices. This versatile acupuncture technique can be used in reason why one uses drugs. Acupuncture efficacy is any out-patient, hospital or residential setting as well directly related to its power to modify behaviour, calm- many other locations such as prisons, neighbourhood ing and inducing sleepiness in a patient who was aggres- centres and clinics where counselling, either individual sive and verbal 15 minutes beforehand. Relaxation (not or group, may take place.
to be confused with the sedative effects of tranquillisers) Acupuncture entry into general medicine is long and the reduction of stress are the effects reported by the awaited. The Lincoln Clinic, like many of the other hospitals and clinics that house acupuncture detoxifica- Unpublished research at Lincoln Clinic indicates that tion programs, has now enlarged their acupuncture acupuncture treatment of crack/cocaine users is effec- program to include general medical problems. The rea- tive and is the most widely used treatment for crack son is clear - not only does acupuncture work but it is dependency in New York city. Indeed experimental extremely cheap. Burdening health costs are a major pharmacological treatment for cocaine dependence concern for any government which sees ever escalating (Desipramine [DMI] and Amantadine [AMA]) showed health service costs. Governments from Hungary and far less effect on abstinence from cocaine than acupunc- England to the new Clinton administration in the USA ture only in a research context6. Lincoln Clinic alone has are now starting to realise that many patients can be treated 3,000 crack/cocaine users per year since 1987, treated effectively and cost-efficiently by TCM.
where 60% of new patients dependent on crack give a At the moment, referrals from the Criminal Justice series of clean urine tests within several weeks.
Department in New York City make up a majority (75%) Acupuncture has helped Native American alcoholism of the treatment population at the Lincoln Clinic. It is programs on Crow and Sioux reservations to make a estimated that 65% of these become drug free (as tested breakthrough in alcoholic detoxification. Alcohol abuse by daily urine toxicology) for 2 months or more. Smith is extremely common among these native populations.
outlines10 that the scenario of chemical dependency treat- Programs showed a 500% increase in daily volume of ment for criminal justice referrals is quite different, as the treatment after the implementation of acupuncture. Pa- patient has to abstain to stay out of prison. They have tients showed "new-found calmness, respect for them- used the same basic principles for chemical dependency selves and consequently a growing interest in the coun- i.e. daily acupuncture, brief daily counselling and taking selling components of the program"7 and further, the daily urine samples. Smith continues that "we are func- Sioux called acupuncture "takus kanskah" in the Lakota tioning at the same rhythm as the patient's struggle for language, meaning "the mysterious power that moves recovery" and that the patient replaces the previous or flows through life". Many also remarked that the adversaries (counsellors, court systems) with a non- TCM approach was similar to their traditional health judgmental urine analysis machine. In this way counsel- ling and detoxification can be totally separated from Saudi Arabia has had such a successful acupuncture judgement and evaluation. This important process re- JOURNAL OF CHINESE MEDICINE NUMBER 45 MAY 1994
lieves most of the pressure felt by drug and alcohol workers whose role is transformed, by the patient them-selves, from being judgmental to being supportive (coun- 1. Wen H.L., and Cheung S.Y.C., Treatment of Drug sellor "burnout" and high turnover is often encountered Addiction by Acupuncture and Electrical Stimulation, in drug and alcohol programs).
Asian Journal of Medicine 9, 1973.
Acupuncture detoxification programs combined with 2. Bensoussan A., The Vital Meridian, Churchill Criminal Justice Agencies are currently working in many Livingstone, 1990.
North American cities. In Portland Oregon the alcohol 3. Smith M.O., Squires R., Aponte J., Rabinowitz N. and detoxification program has reported that 85% of patients Bonilla-Rodriguez R., Acupuncture Treatment of Drug now complete the program compared to 34% prior to the Addiction and Alcohol Abuse, American Journal of use of acupuncture. 6 month recidivism has also dropped, Acupuncture 10, 1982.
from 25% to 6%11.
4. Bullock M. L., Culliton P. D., Olander R.T., Controlled The Miami Dade acupuncture detoxification program Trial of Acupuncture for Severe Recidivistic Alcoholism, based entirely on court-referred clients, is a unique suc- The Lancet 24/6/89.
cess story; it is the forerunner to the current eight func- 5. Margolin A., Avants K., Chang P., Kosten T., Acu- tioning programs based on court referrals and another puncture for the Treatment of Cocaine Dependance in eleven which are in the planning stage. Started in 1990, Methadone Maintained Patients, The American Journal and functioning on the already successful Lincoln Clinic on Addictions, Summer 1993.
model, the court system diverts drug-related offenders to this program and uses daily urine toxicology readings 7. Smith M.O., Khunat R., Oliveira A., Acupuncture as the proof of drug rehabilitation. A 2 year statistical Treatment for Alcoholism, NADA Literature Clearing update shows that of 4296 drug possession arrestees House Vancouver USA, 1986.
who entered the program, 1600 graduated as being drug 8. NADA European Conference, Budapest, Hungary, free and have a 3% re-arrest rate; 1153 are still in the October 1993.
program, having fluctuating urine toxicology results and a 7% re-arrest rate; 500 had their charges dismissed; 10. Smith M. O., The Use of Acupuncture Detoxification in 1043 left, failing to comply with the program (of whom the Criminal Justice System, testimony presented to the most left in the first 2 weeks of participation). The New York City Council 21/3/88.
effectiveness of the program is enthusiastically accepted by judges and offenders alike. Only 16 (1%) of those who 12. The Miami Success Story, NADA literature, Clearing graduated were rearrested. A comparable study of first House, Vancouver USA.
time offenders in 1987 showed that the re-arrest rate was 13.Smith M. O., Lincoln Hospital Acupuncture Drug Abuse Program, testimony presented to the NIH office of The justice system is interested in drug and alcohol Alternative Medicine and The National Wellness programs - not to ensure that a first offender achieves Coalition. 21/5/93.
abstinence, but primarily to prevent resumption of crimi-nal activity after graduation from a program. Continued abstinence, as recorded by urine testing, can therefore beused to dismiss charges. Relapse is often catastrophic, as David Blow Dip. App. Sc. (Acup.)
offenders return to initial levels of alcohol consumption • Graduated in 1988 with a government accredited and drug use, signifying reversion into criminal activity.
Diploma Applied Science (Acupuncture), Acupuncture The above re-arrest rates are important as they reflect Colleges (Australia) Sydney Australia.
the effectiveness of this out-patient clinic program inte- • Founding member of the Nanjing Association, Rome grated with the daily social activity of the patient. Resi- dential social models of drug and alcohol treatment are • Italian NADA ( National Acupuncture Detoxification often considered the treatment of choice, as the environ- Association ) Co-ordinator.
ment is in contrast to that outside, being clean, safe andhealthy. Their success, however, is often marked byrelapse during the reintegration phase and the pro-longed wait for re-entry. In acupuncture programs, re-lapse is often shallow and is accepted as a part of absti-nence progression. People may return easily as there areno waiting lists. The struggle is "one day at a time" asphysiological/psychological abstinence is juggled withdaily social and economic factors.
Recovery for an addicted person involves not only their relationship with the outside world, but more sotheir relationship with the self - the power of healingfrom within which is integral to treatment by TraditionalChinese Medicine.

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