Developed in the 1970s at Lincoln Hospital (Bronx, N.Y.),

the National Acupuncture Detoxification Association

(NADA) protocol was originally used as a supportive

component in drug and alcohol treatment settings.

The 3-5 point ear acupuncture formula controlled

withdrawal symptoms and helped patients become

more clear-headed and comfortable. Nearly 1,000

licensed drug treatment programs use acupuncture in

the U.S. according to federal N-SSATS statistics.

The 21st century has brought a remarkable expansion

in the use of the NADA protocol. It is used in 130

prisons in England. Correction officers provide all the

treatments under a 5-year training contract by SmartUK.

The jail program was expanded because of an 80%

reduction in violent incidents. Post-trauma treatments

have been given to community members after 9/11 and

Katrina. Treatments for firemen have been permanently

institutionalized in both cities. Ear acupuncture for stress

has been used by thousands of military personnel in India

through NADA-India.

NADA acupuncture has changed the face of psychiatric

hospital care in Northern Europe. 3,000 nurses have

been trained in 100 different government facilities.

Refugee services in war-torn areas have been particularly

impressive. The DARE program in Thailand has provided

ear acupuncture for many years with a dozen different

Burmese tribes in border camps. NADA was introduced

during a 2-week training sponsored by Real Medicine

Foundation in refugee camps in East Africa in May

2008. By the end of the year, 18,000 treatments were

provided by the refugee trainees. Support was provided

for survivors of a violent land dispute.

NADA members have used magnetic beads to treat

children with ADHD and autism-spectrum disorders,

and violence-prone adolescents. The beads are placed on

the back of the ear opposite the shen men point. The

bead remains in place with an adhesive for 1-2 weeks at

a time. Many instances of prolonged improvement have

occurred, but this technique is only in an early stage of


NADA acupuncture is used on a public health model.

Treatments are commonly given in large groups on a

frequent basis. Patients sit quietly for 45 minutes in a

collective experience. Many jurisdictions have laws that

allow a wide range of clinical personnel to be trained to

use the NADA protocol in state approved facilities under

general supervision of a fully licensed acupuncturist or

physician. States that do not have this provision, such

as Florida and California, have few NADA programs

in comparison with states like Virginia and New York

which do have this arrangement.

NADA uses 5 ear acupuncture points: sympathetic, shen

men, lung, liver and kidney. In many settings only the

first 3 points listed above are used. Results seem to be

similar with 3 points, and there is less expense in Third

World settings. NADA training also involves sterile

precautions and social integration with other services.

Apprenticeship training is always necessary because the

clients are often troubled and distracted. NADA is a

non-verbal approach. There are no diagnostic procedures.

The ear points provide a balancing effect: some fall

asleep; some feel relief of depression; some seem to be

meditating. These balancing effects continue from one to

several days even though the patient may be exposed to

contrasting emergencies during that time. It is a coping

and preventive effect. As an added note, Lincoln used

electroacupuncture extensively in the ’70s. Symptom

relief lasted 6-8 hours. Our patients always preferred the

prolonged preventive effects of manual acupuncture.

NADA acupuncture adds a valuable component to

the behavioral health fields. Its worldwide validation

strengthens the entire acupuncture profession.

At Lincoln we began by copying Dr. Wen’s formula of

using electro acupuncture on the lung point. By accident,

our electrical stimulator broke, so we were able to learn

that manual stimulation provides a much more prolonged

and more preventive effect than electrical stimulation.

I started with Lung and Shen Men (the name says it

all). Then we took resistance values from dozens of ear

locations – with no clear outcome. I tested for tenderness

and sensitivity for all the lumbar to sacral points (choosing

these to build yin, rather than using the always tender

upper spinal and endocrine points).

The closer to the sacral location, the more tenderness

occurred – so I used the Sympathetic. We added the Liver

because of its stress and anger identity. The Kidney was

added to help methadone patients with chronic edema.

Sympathetic and Shen Men both link to the kidney level

of the spine.

I have never seen any evidence of usefulness for the EarKidney

in this formula. I use a Lung point which is close

to the stomach area – hence it is a diaphragm-oriented

lung point. Most everyone else uses a lung point adjacent

to the cervical spine.

In recent years I have encouraged a 3-point formula

(Sympathetic, Shen Men, Lung) for stress, outreach,

trauma, and non-U.S. settings. I have always felt 5

needles are too crowded.


The Lincoln Hospital Substance Abuse Division has been

detoxifying alcoholic clients with acupuncture for the

past 10 years. We combine these innovative methods with

the conventional modalities of counseling and in-patient

detoxification. We see more than 280 detoxification

clients daily in an inner city walk-in clinic. Our program

is nationally known: Alcoholic clients have flown here

from Cincinnati, New Orleans and Beverly Hills for the

1-2 week acupuncture regimen.

Acupuncture detoxification is relatively simple to

learn and apply. Small needles are inserted just under

the skin at several locations on the external ear.

Clients usually begin acupuncture out of curiosity or

desperation. They continue to come for treatments as

they appreciate the success of the treatment. Clients

who come in tremulous often fall asleep during

treatment. Clients who come daily for more than a

week find it easier to remain sober and are visibly more

relaxed, alert and confident. Some motivated as well as

poorly motivated clients report that daily acupuncture

treatments make it very difficult to keep drinking.

Several have told us that they still hang out with their

drinking buddies but "don’t feel like drinking”.

We have recently received a large funding increase from

the City of New York which enabled us to implement

sobriety agreements and breathalyzer testing on selected

“problem" clients. We have many clients referred by

Social Service or word of mouth who sober up relatively

early with acupuncture. Of 85 recent "problem" clients

(initial treatment failures, psychotic-alcoholic patients,

and child abuse referrals). 60 had a substantial period

of clean breathalyzer tests within 2-3 weeks of starting

acupuncture and a sobriety agreement. These patients

received relatively little counseling during this period.

An acupuncture detoxification clinic in Brooklyn was

set up in August '83 as part of Kings County Hospital

Substance Abuse Service. The director, Dr. Bernard Bihari,

and his acupuncture staff are students of ours. Their

results in sobering up chronic alcoholics have been very

impressive. This clinic is treating only long term patients

already enrolled in their program so they have very clear

records of their patients pre- and post-treatment status.

30 Kings County alcoholism clients have been referred

to acupuncture because of frequent positive breathalyzer

tests and recurrent need for in-patient detoxification. 24

of these patients have not had a positive breathalyzer test

since their first day of acupuncture! Testing is still done

daily. These acupuncture clients--prior misfits--have

become leading sobriety role models in the alcoholism

counseling program.

Counseling Support Is Necessary

Many people in this field burn themselves out trying

to use counseling methods only to cope with chronic

tension, craving and insomnia. These symptoms reflect

total body imbalance, not only psycho-social imbalance.

Nagging physical withdrawal symptoms and debilitating

fears of “white knuckle sobriety” respond quite well to

acupuncture and herbology combined with counseling

methods. Our treatment methods help the counselor’s

efforts to be much more fruitful.

Since acupuncture is inexpensive and non-addicting, we

can easily offer acupuncture treatments “on demand,"an

addict in withdrawal need not be placed on a waiting

list and be lost to follow-up. The cost of acupuncture

detoxification is much less than alternate protocols.

Acupuncture treatment can be provided within a general

medical setting so that treatment of significant others

and any concurrent psychiatric and abuse problems can

occur simultaneously. Repeat in-patient detoxification is

inappropriate for relapsing clients who have not yet built up

a substantial habit. By offering treatment “on demand,” the

acupuncture detoxification protocol minimizes the barriers

for the former client to reenter treatment. Discussions of

stressful psycho-social issues can be delayed until after the

client has received renewed relief and reassurance by the

effectiveness of acupuncture treatment.

Alcoholism clients are particularly appreciative of a

concerned, giving atmosphere. Acupuncture allows the

staff to help give relief without any security concerns or

financial risk. The acupuncturist wants to hear about any

additional physical symptoms because it helps modify

the point selection. We have had additional success in

treating nerve and liver disease which are secondary to

alcoholism. Physical complaints which are sources of

nagging irritation in the usual treatment setting thus

become a useful communication in the acupuncture

detoxification setting.

Herbal Detoxification

Herbal treatment has been used for alcohol detoxification

and nervous relaxation for thousands of years in many

parts of the world. The herb mixture that we rely on

contains chamomile, catnip, peppermint, skullcap, hops

and yarrow. The herbal mix is prepared exactly as tea is

prepared, using honey instead of sugar. The mixture is National Acupuncture Detoxification Association 9

less expensive than coffee. Our Lincoln “sleep-mix” can

be used for relaxation and insomnia in stable persons.

The same mixture is effective for alcohol detoxification

if taken on an hourly basis. These herbs are not habit

forming and do not have any risk of overdose or misuse.

Our "herbal formulary" explains the nature and effects of

these ingredients more completely.

Nation-Wide Acupuncture Training Program

In the past decade we have trained over fifty people

to be acupuncturists who were previously counselors,

nurses, social workers, psychologists and physicians in

conventional drug and alcohol treatment settings. Some of

these acupuncturists have continued their study of Chinese

medicine to become experts in general acupuncture therapy.

Other trainees have focused on learning ear acupuncture

for detoxification treatment. Our trainees are working in

numerous public and private substance abuse treatment

settings across the U.S. and in Europe. The first national

convention on acupuncture-detoxification is being held in

Washington, D.C., April 18-20.

In our specialty, a disproportionate amount of time and money

are spent on in-patient detoxification. Using acupuncture

treatment as an adjunct to outpatient alcoholism treatment

permits a much larger group of clients to be served and

enables all of us to invest more heavily in the interpersonal

and spiritual aspects of rehabilitation


In a placebo-controlled study, 80 severe recidivist

alcoholics received acupuncture either at points specific

for the treatment of substance abuse (treatment group) or

at nonspecific points (control group). 21 of 40 patients

in the treatment group completed the programme

compared with 1 of 40 controls. Significant treatment

effects persisted at the end of the six-month follow-up:

by comparison with treatment patients more control

patients expressed a moderate to strong need for alcohol,

and had more than twice the number of both drinking

episodes and admissions to a detoxification centre.


For centuries, acupuncture has been used in Far Eastern

countries for various human ailments.1

 Only lately,

however, has acupuncture been used to treat addictive

disorders. Chinese textbooks on acupuncture1-3 do not

refer to addictive drugs or to the treatment of addictive

disorders, but the suggestion that acupuncture can be

effective in the treatment of alcoholism,4,5 has led to

its use with alcoholics and drug-addicts.6,7 Controlled

studies of the efficacy of acupuncture in alcoholism have

not been reported.

In a pilot study,8

 we evaluated the efficacy of acupuncture

therapy in recidivist alcoholic subjects: patients receiving

acupuncture at points that were specific for substance

abuse were more likely to complete the course of therapy

than patients receiving acupuncture at nonspecific

(placebo) points. Moreover, "treated” patients had

substantially fewer drinking episodes and fewer

admissions to a detoxification centre. However, we did

not know whether these beneficial effects recorded during

therapy would persist during a follow-up period when

no scheduled therapy was given. We have now tested

the null hypothesis that such beneficial effects during

acupuncture therapy would not persist for six months.


Patients and Facilities

Between December, 1986, and October, 1987, patients

eligible for this study were identified by the chronic

case management division of the Hennepin County

Detoxification Center, an 88-bed establishment in

central Minneapolis where severe "skid-row" alcoholics

may receive care for up to 72 h without charge. At the

time of this study, treatment was based on the "medical"

model of detoxification: medications were given to

ease functional complaints and to control early signs

of alcohol withdrawal. Nursing staff were present at

all times and rounds were made daily by a resident in

internal medicine from the Hennepin County Medical

Center (HCMC), which provides medical backup for the

detoxification centre. Alcoholic patients are assigned to

the appropriate level of care by the nursing staff according

to protocols drawn up by the staff and medical director of

the detoxification centre. Patients may be referred to the

HCMC emergency room at any time for evaluation or

admission. The detoxification centre admits over 14,000

patients a year; 91% are male.

Patients were selected for this study by the nurses and

personnel of the detoxification centre: every patient

was considered as a possible study candidate. The

following criteria were established for entry to the study:

age over 18 years; ten or more total admissions to the

detoxification centre or five admissions in the most

recent calendar year; previous inpatient or outpatient

treatment failure (ie, patient left the programme); and

no full-time employment (according to history) for at

least the previous six months. Patients were excluded if

they had previously received acupuncture therapy or if

they were pregnant. The first 80 patients who satisfied

these criteria and who gave informed consent were,

after a standard 3-5 day detoxification, admitted to the

study and transferred to Mission Lodge — a long-term

chemical dependency treatment centre in Plymouth,

Minnesota, 11 miles from the detoxification centre. Each

Monday morning after arrival, Mission Lodge personnel

escorted patients to the treatment area where their

names were entered consecutively in a treatment ledger.

Patients were then assigned by pairs either to treatment

group or to control group by alternate selection. Neither

Mission Lodge personnel nor the acupuncturists had any

knowledge of the patient’s demographic profile obtained

during intake, and Mission Lodge personnel were never

aware of patient's treatment group status.

Study Design

This was a blinded study. The acupuncturists knew which

patients were receiving true acupuncture treatments,

whereas the patients, the Mission Lodge personnel, and

the follow-up coordinator did not. All study patients

were housed and received their acupuncture therapy

at Mission Lodge. Individual counselling and group

therapy were not provided as part of the study; but all

residents at Mission Lodge must attend Alcoholics 12 National Acupuncture Detoxification Association

Anonymous meetings twice a week and are discharged if

they do not. Study patients were free to come and go, and

transportation to and from Minneapolis was available at

no charge. The drinking of alcohol after study entry was

not regarded as grounds for dismissal from the study.

The treatment period was divided into three phases: in

phase I, patients received one acupuncture treatment

a day from Monday to Friday for two weeks; in phase

II, one treatment was given every Monday, Wednesday,

and Friday for four weeks and in phase III, acupuncture

was given on Mondays and Thursdays for two weeks.

Patients were then discharged from Mission Lodge and

were asked to return after one, three, and six months to

complete a follow-up summary sheet: this consisted of

six multiple-choice and check-off questions that were

designed to assess the subject's need for alcohol, ability to

stay sober, and ability to undertake productive initiatives

during the study period. Subjects answered the same

six questions at each of the three follow-up interviews.

All follow-up sessions were conducted by the study

coordinator, who was blinded to the subject's treatmentgroup.

Furthermore, his interaction with the subjects

was limited to evaluating their reading ability (all could

read) and collecting the completed questionnaires. When

subjects did not return for a scheduled follow-up visit, the

study coordinator organized searches in local bars, free

food centres, treatment programmes, and hospitals, and

questioned other street alcoholics. Also during follow-up

subjects could ask for additional acupuncture treatments.


Patients who completed the entire study received $100—

ie, $10 if they completed the intake process, $15 for each

of the three successfully completed treatment phases, and

$15 for each completed scheduled follow-up interview.

Acupuncture Protocol

Traditional Chinese acupuncture1

 was used: acupuncture

points are electrically discrete—ie, their location can be

confirmed by an ammeter.9

Standardised acupuncture treatments were given by two

experienced acupuncturists. Patients in the treatment

group received acupuncture treatment at ear points now

regarded by Wen10-12 and the Lincoln Hospital group

(New York)5

 as specific for chemical dependency after

nearly 15 years of clinical experience. Three ear points

(Shen Men, lung, and sympathetic points) were used

in all treatment patients. Control patients were treated

at ear points not specific for chemical dependency

but close enough ( < 5 mm) to the specific points that

treatment and control patients could mingle in the same

room and yet not notice any differences in treatment.

A single specific hand point, LI4 Hoku,1

 was also used

in treatment patients for anxiety, while control patients

received a nonspecific hand point. At each patient’s first

treatment session, the site of all points was confirmed by

a ‘Royer-Anderson’ neurometer (Cadre Corporation, San

Mateo, California): specific points gave a reading of > 50

mA, whereas nonspecific points always registered zero.

Acupuncture treatments were given in a group setting

with treatment and control patients seated side-by-side in

comfortable chairs in a large open room. After the site was

cleansed with an alcohol swab, fresh needles were inserted

to a subcutaneous depth of about 0.5 mm. All ear and

hand points were placed bilaterally. The treatments were

Table I-Demographic Characteristics


No of Patients

Treatment group

(n = 40)

Control group

(n = 40)








Marital Status


















Native American











Support person/group







On welfare







DWI arrests










Other alcohol-related arrests










DWI = driving while intoxicatedNational Acupuncture Detoxification Association 13

given without manual or electrical stimulation and lasted

about 30 min. Interaction between the acupuncturists

and the patients was limited to the time required for

needle placement and casual group (never individual)

conversation. The acupuncturists were not involved in the

assignment of patients to treatment or control groups, data

collection, or evaluation of outcome measures.

Statistical Analysis

Analysis was done according to initial treatment

assignment. Categorical variables were evaluated by c



analyses and Fisher’s exact test was carried out if cell sizes

were less than 10. A p value of less than 0.05 was regarded

as statistically significant for the comparison between the

treatment and control groups. Continuous data were

analyzed by Student’s t test. When the variances in the

two groups differed significantly, the t test for unequal

variance was done.

A power analysis was performed with the estimates from

our earlier work.8

 We estimated that the acupuncture

group would have at least 20% more responders in

terms of the endpoints of decreased desire for alcohol,

decreased number of detoxification centre admissions,

and self-reported drinking episodes. We also assumed

that the loss to follow-up rate could be as high as 50%

in each group. We calculated that, to have a 0.90 power

and a type I error of p < 0.05, we would need 20 subjects

in each group at the end of the six months of follow-up.

Thus, to allow for a 50% loss to follow-up, the size of

each group was set at 40.13


Patient Population (Table I)

The mean age of the patients was 42.2 years (range 23-71);

75 (93.8%) were men. The patients were predominantly

white (61.3%); Native Americans were the second

largest group (27.5%). 92.5% of the patients were single,

separated, or divorced, and hardly any had a family or

support network at the time of study entry. Educational

levels of patients in the treatment and control groups

were comparable. All patients had been unemployed

at the time of study enrolment (mean 26.8 months).

50 patients received welfare assistance (mean duration

Table II—Alcohol/Drug Abuse and Treatment History

Before Study Entry

Patient Variables

No of Patients

Treatment Group

(n = 40)

Control Group

(n = 40)

Substances Abused



















Pattern of Drinking










Mean Duration of

Alcohol Abuse (YR)

< 16



> 25












No of Inpatient

Treatment Programme










No of Outpatient

Treatment Programmes

(AA encounters)










‘Antabuse’ Programmes










Detoxification Centre





> 21









*2 yr before study entry.

AA = Alcoholics Anonymous.

Table III—Completion Rates for Each Treatment Phase

Treatment Phase*

No of Patients (%)

Treatment Group

(n = 40)

Control Group

(n = 40)

I 37 (92.5) 21 (52.5)

II 26 (65.0) 3 (7.5)

III 21 (52.5) 1 (2.5)

*p < 0.001 for the difference between the completion rate for

each phase.14 National Acupuncture Detoxification Association

11.4 months). There were no significant differences in

demographic characteristics between the treatment and

control groups.

Substance Abuse and Treatment History (Table II)

All study patients said that alcohol was their primary drug

of abuse at the time of entry to the study, although 24

(30.0%) reported past episodic use of other drugs such

as sedatives, opioids, stimulants, tranquilizers, or cocaine.

However, there were no differences in drug use before

enrolment between the two groups. Patients who were

daily or binge drinkers were equally distributed in the two

groups. 40% of all patients had begun to abuse alcohol

by the age of 15; the mean years of alcohol abuse were

23 for the treatment group and 21 for the control group.

All patients had numerous previous admissions to alcohol

treatment programmes, but there was no significant

difference in treatment history between the two groups.

Completion of the Treatment Phase (Table III)

The completion rate for each phase of the treatment was

significantly higher for patients in the treatment group.

Only 3 (7.5%) treatment patients terminated therapy

during phase I, compared with 19 (47.5%) control

patients (p < 0.001), and a striking attrition of control

patients continued during phases II and III. Only 1

(2.5%) control patient completed all three phases of

treatment compared with 21 (52.5%) of the treatment

patients (p < 0.001).

Follow-up After Treatment

During the six-month follow-up, interview data were

obtained from 61 (77.5%) patients. Although some

patients did not return for their second and third

interviews, the third interview was completed by 27

(68%) and 23 (58%) of the treatment and control

patients, respectively.

Alcohol need (table IV)—At each of the follow-up

intervals, more control patients than treatment patients

expressed a moderate to strong need for alcohol.

Furthermore, treatment patients did not have an increased

need for alcohol as the follow~up period progressed.

Also, 12 patients in the treatment group asked for and

received additional acupuncture therapy during the

follow-up period, whereas only 1 control patient did so

(p < 0.001). Most of these patients asked for additional

treatments (mean 3.7, range 1.7) to help maintain their

sobriety usually during a single follow~up interval; 3

patients requested treatment during two consecutive

follow-up intervals. 9 of the 12 treatment patients that

had requested additional therapy completed all three

treatment phases, but 10 had had drinking episodes

and had been admitted to the detoxification centre. The

impact of this additional therapy on the patient’s course

is therefore difficult to assess.

Drinking episodes (tables V and VI)—The following indicators,

because of their possible relevance to treatment efficacy, were

Table IV—Assessment Of Need For Alcohol During

Each Follow Up Interval

Follow-up Interval

No of patients

Moderate to


Indifferent to


One Month

Treatment Group

Control Group





Three Months*

Treatment Group

Control Group





Six Monthst

Treatment Group

Control Group








Table V—Self-Reported Drinking Episodes During Each

Follow Up Interval

Follow-up Interval No of Drinking


Mean (SEM)



One Month**

Treatment Group (34)

Control Group (28)



3.15 (1.03)

5.71 (1.29)

Three Months***

Treatment Group (32)

Control Group (25)



3.15 (0.96)

11.61 (2.31)

Six Monthst

Treatment Group (27)

Control Group (22)



3.57 (1.16)

10.52 (2.41)

*Total = 308 for treatment group and 704 for control group

**No of patients available for interview during each follow-up

interval. Some patients refused to answer questions about no of

drinking episodes.

***p < 0.001


p < 0.01National Acupuncture Detoxification Association 15

recorded during the follow-up period: episodes of drinking,

as reported by the patient (an episode was defined as the

consumption of at least three drinks); admissions to the

detoxification centre; and hospital admissions and emergency

room visits. Control patients reported more than twice

the number of drinking episodes than treatment patients.

Furthermore, 39 control patients and all treatment patients

who did not complete all three phases of treatment reported

drinking episodes during the six-month follow-up. By

contrast, 6 (28.6%) of the 21 patients in the treatment group

who completed all three treatment phases claimed that they

had not taken any alcohol, and none of these were admitted

to the detoxification centre during this period. 4 treatment

patients who completed the treatment protocol reported only

one drinking episode and on follow-up had been admitted to

the detoxification centre only once. It is also noteworthy that

during all three follow-up intervals treatment patients were

more likely to report abstinence than controls.

Admissions to detoxification centre (table VII ).—There

was a pronounced difference between treatment and

control patients in the number of admissions to the

detoxification centre. At all three follow-up intervals, the

number of control patients admitted to the detoxification

centre was more than twice that of treatment patients: 15

of the 21 patients who had been admitted five times or

more were from the control group; 5 of the 6 treatment

patients with this many admissions did not complete all

three phases of treatment. The 7 patients who had been

admitted ten or more times to the centre during the sixmonth

period were from the control group; no treatment

patient was admitted to the detoxification centre this

often. Hospital admissions and emergency room visits

were few during follow-up and were not significantly

different for treatment and control patients.

Other possible indicators of treatment efficacy were also

monitored. 30 (75%) treatment patients compared with

19 (48%) control patients undertook productive initiatives

such as applying for employment, enrolling in classes,

or reconciling with a spouse or family. It was impossible,

however, to determine how sustained these efforts were.


Our findings show that acupuncture can be effective

for treatment of severe recidivist alcoholics. Some of

the limitations noted in our pilot study must again be

mentioned. For example, although more patients in the

treatment group than in the control group completed each

treatment phase, there was a high drop-out rate among

control patients, despite the promise of incentive payment.

We believe, however, that our analysis is valid since, as in

our pilot study, patients who terminated the treatment part

of the study did not differ in their baseline demographic

characteristics; and despite the reduced power to detect

group differences, statistically significant results were

obtained during phase III when the smallest number of

patients was available for study. Also, we realize that the

use of a breath analyzer to monitor drinking episodes

would have been desirable: drinking episodes during the

follow-up period were, of necessity, self-reported. The

validity of such self-reporting in alcohol studies remains

controversial.14 However the ratio of drinking episodes

reported by control compared with treatment patients

(> 2/1) is comparable with the ratio of admissions to the

detoxification centre in the two study groups. Could the

acupuncturists have inadvertently conveyed to the patients

whether treatment was correct or incorrect? We believe

that this is unlikely because acupuncturists were asked

Table VI—Self-Reported Abstinence Versus Continued

Drinking During Each Follow Up Interval

Follow-up Interval No of Drinking Episodes

None Some

One Month

Treatment Group

Control Group





Three Monthst

Treatment Group

Control Group





Six Monthst

Treatment Group

Control Group








Table VII—Admissions to the Detoxification Centre

During Each Follow Up Interval

Follow-up Interval No of


Mean (SEM) no

of Admissions

One Month**

Treatment Group (36)

Control Group (31)



0.62 (0.20)

1.54 (0.32)

Three Monthst

Treatment Group (33)

Control Group (26)



0.59 (0.17)

1.67 (0.42)

Six Monthst

Treatment Group (29)

Control Group (24)



0.69 (0.41)

1.56 (0.20)

*Total = 75 for treatment group and 186 for control group

**p < 0.01


p < 0.0516 National Acupuncture Detoxification Association

not to converse individually to the patients and because

treated and control patients were seated side-by-side when

receiving acupuncture. Although we did not ask patients if

they knew which treatment group they had been assigned

to, several volunteered accurate opinions.

This study may have relevance for various aspects of

alcoholism therapy. First, increased use of acupuncture

therapy not only may be an effective adjunct to therapy in

current programmes for patients with persistent craving

for alcohol, but also may allow treatment to be extended

to a large group of recidivist alcoholics for whom current

therapies are not effective. Second, the high retention rate

observed in the treatment periods of both the present and

the pilot studies was especially encouraging, since additional

time in therapy allows benefits to accumulate both from

acupuncture therapy and from other forms of intervention.

Third, acupuncture is highly cost-effective: overhead costs

are low, equipment needs are negligible, therapy is easily

given on an outpatient basis, and numerous patients

can be treated simultaneously by one acupuncturist

supported by a small ancillary staff. Also, increased use

of acupuncture therapy may eventually lead to a decrease

in the number of inpatient admissions to expensive

treatment centres. For example, the total cost for

admissions to the detoxification centre (average stay 30 h)

for control patients over the six-month follow-up period

was $20,424 higher than that of treatment patients.

Alcoholism is a major health problem in American

society;15 it is also the most expensive with an annual

estimated cost of 117 thousand million dollars. 16

Psycho-social treatment with minimum participation

of the physician community is the standard of care for

alcoholic patients. However, the efficacy of psycho-social

alcohol therapy, has been questioned.17,18 The drop out

rate in all programmes is high-probably over 50%. Clearly,

therefore, alternative treatments must be investigated and

developed to increase the percentage of severe alcoholics

who can be successfully treated. We believe that our

results are encouraging enough for other research groups

to validate the efficacy of acupuncture in the treatment of

various subsets of the alcoholic population.

We thank Dr. Morrison Hodges, Dr. Phillip K. Peterson, Dr. Thomas

J. Kiresuk, and Dr. Burt Sharp for their support and careful review of

the manuscript; and Diane Loudon for preparation of the manuscript.

This study was supported by the Hennepin County Department of

Community Services, Chemical Health Division, and by a research

grant from Hennepin Faculty Associates.

Correspondence should be addressed to M. L. B., Hennepin

County Medical Center, Department of Medicine, 701 Park

Avenue, Minneapolis, Minnesota 55415, USA.

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comprehensive text (Shanghai College of Traditional

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Academy of Oriental Heritage, 1978.

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Foreign Language Press, 1980.

4. Shakur, M and Smith, M. The use of acupuncture in the

treatment of drug addiction. Am J Acupuncture 7 (1979),

pp. 223–28.

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RB. Acupuncture treatment of drug addiction and alcohol

abuse. Am J Acupuncture 1982; 10: 161-63.

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addiction to crack. New York Times Sept 30 1988, p 9.

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5 1988, p 1.

8. Bullock, M.L., Umen, A.J. Culliton, P.D., Olander, R.T.,

Acupuncture treatment of alcoholic recidivism: a pilot

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western view. Postgrad Med 1983; 74:60-67.

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acupuncture and electrical stimulation. Asian J Med 1973;

9: 138-41.

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addiction by electro-acupuncture. Mod Med Asia 1975;

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outpatient detoxification. Mod Med Asia 1979; 15: 39-43.

13. Siegal S. Non-parametric statistics. San Francisco: W.H.

Freeman, 1956.

14. Fuller RK, Lee KK, Gordis E. Validity of self-report in

alcoholism research: results of a Veterans Administration

cooperative study. Alcoholism (NY) 1988; 12: 201-05.

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Alcoholism (UCLA Conference). Ann Intern Med 1984;

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who benefits? Am Psychol 1986; 41: 794-805.

18. Holden C. Is alcoholism treatment effectiv


We all know that most substance abusers do not have

access to treatment. Our recent experience in New York

City highlights the inadequacy of our therapeutic system.

The 1984 police sweeps on the Lower East Side exposed

one particular group of 4,000 addicts. Only very few

of those people were able to enter treatment programs.

Most were simply returned to the streets because no

treatment and/or correctional program was available. The

most widespread forms of current abuse — (1) cocaine

abuse and (2) poly-drug abuse — are not in any way

susceptible to the most available form of treatment which

is methadone maintenance. Furthermore, most people

who currently enter treatment do so only after years of

abuse, debilitation, and consequent social tragedy.

We desperately need a form of treatment that will (1) be

readily acceptable with abusers of all social classes, (2)

lead to effective long term psycho-social rehabilitation,

(3) be inexpensive and convenient to establish and (4)

not involve diversion, or other individual and social

side effects. The Substance Abuse Division of Lincoln

Hospital has spent the past ten years developing an

acupuncture-based treatment protocol to satisfy these

four requirements.

The Acupuncture Clinic at Lincoln Hospital has been

operating for 11 years in the South Bronx, a Black

and Latin “ghetto” community in New York City. Our

program began using acupuncture as an effort to provide

better treatment for drug addicted clients receiving

methadone detoxification. 6 years ago we eliminated

methadone as a treatment modality. We have expanded

to serve 300 acupuncture patients daily with an average

of 15 intakes each day. 75% of our patients are drug and

alcohol detoxification clients. The remainder are general

medicine clients, including a number with psychiatric

problems. Nearly all of our patients receive acupuncture

while seated in a large open treatment area. As needed,

patients are provided with supportive psycho-social

counseling as well as a wide range of native American

and European herbal preparations.

Hard-core addicts are usually shocked to discover that

daily acupuncture can relieve withdrawal symptoms as

reliably as the drugs they use. Acupuncture can prevent

the sensations of drug craving even if none of their

personal problems are resolved. The severity of acute

withdrawal symptoms is independent of psycho-social

issues; whereas the continuation of long term escapist

drug seeking behavior is usually dependent on psychosocial

balance. Therefore it is very important to integrate

the acupuncture treatment with counseling and other

psycho-social services. Merely establishing a room staffed

by acupuncturists who do not have personal experience

in substance abuse treatment and on-going support from

staff in other program components has been shown to be

not effective.

Acupuncture has been used for more than 2,000 years.

It was a primary component of drug abuse therapy in

post-war Viet Nam. It is extremely safe and convenient

to establish in virtually any setting. We primarily use ear

points in detoxification treatment. Sessions cost $5-10

each in actual expenditure. An average client might have

15 short term crisis treatments and then another 10-15

treatments over the next year.

Since acupuncture is inexpensive and non-addicting, we

can easily offer acupuncture treatments “on demand.” An

addict in withdrawal need not be placed on a waiting

list and be lost to follow-up. The cost of acupuncture

detoxification is much less than alternate protocols.

Acupuncture treatment can be provided within a general

medical setting so that treatment of significant others

and any concurrent psychiatric and abuse problems can

occur simultaneously. Repeat in-patient detoxification

is inappropriate for relapsing clients who have not yet

built up a substantial habit. By offering treatment “on

demand,” the acupuncture detoxification protocol

minimizes the barriers for the former client to re-enter

treatment. Discussions of stressful psycho-social issues

can be delayed until after the client has received renewed

relief and reassurance by the effectiveness of acupuncture


Acupuncture detoxification enhances the overall patienttherapist

relationship in many ways. Acupuncture points

are selected according to the overall status of the patient so

that it is not necessary to know the patient's current drug

using status to apply treatment successfully. Therefore

we can avoid pressurized encounters with clients about

recent drug use. These confrontations — relatively

necessary to other modalities — often produce such a

climate of guilt and aggression that cooperative treatment

efforts are difficult to attain. When a client returns after

missing a few days (or weeks) of detoxification treatment

we ask how they are feeling; but we can institute effective

treatment even though the client gives a vague, evasive


In our clinic, clients request counseling sessions frequently

during the acute detoxification process. Since they learn to

rely on acupuncture for symptomatic relief of anxiety and

depression, these clients frequently return for treatments National Acupuncture Detoxification Association 19

during the first months of treatment. This process creates

an avenue of easy and frequent communication between

the client and therapists precisely during the crisis periods

of early treatment. Acupuncture clients frequently say that

they can concentrate better during counseling sessions.

Statistical Success

However, it was not until our 100% budget increase of

September 1984 that we were able to hire counseling and

research-oriented staff and have the funds for frequent

testing for abstinence. Our paper “An Innovative

Approach to Chemical Dependency” (by Bliss and

Oliveira) documents the effectiveness of acupuncture

detoxification for the first time in a substantial statistical

sample. The figures for non-treatment agreement

detoxification can be said to represent the success of

acupuncture detoxification of difficult, non-screened

patients with minimal non-structured counseling. 44%

gained consistent abstinence and 12% gained a period

of abstinence of at least 3 testing days (often considered

a positive goal in conventional detoxification protocols).

Even these figures represent considerable success

relative to other detoxification protocols. The treatment

agreement figures indicate the significant advantage we

gained by using our version of an abstinence contract

with these usually troublesome patients. 57% gained

consistent abstinence and 16% gained a period of

abstinence of at least 3 testing days and maintained a

continuing therapeutic relationship during this usually

chaotic and nihilistic period. By using acupuncture

and treatment agreements we have been able to help

73% of a group of patients who are usually considered

untreatable enter the therapeutic process and achieve

clearly documented success. Later in this paper we will

describe case studies reflecting this non-screened, usually

"untreatable" population. Chemical abusers who are

impulsively violent and provocative are well represented

in our long term treatment population.

The Lincoln Acupuncture Program is a successful

revenue-producing unit which is fully integrated within

the public hospital system of New York City. It has served

as a model for the programs in Brooklyn and Minneapolis

described below as well as others in the U.S. and abroad.

The experience of these other programs indicates that our

approach can be taught and implemented successfully in

a wide range of programs.

An acupuncture detoxification clinic in Brooklyn was

set up in August ‘83 as part of Kings County Hospital

Substance Abuse Service. Their results in sobering up

chronic alcoholics have been very impressive. This clinic

is treating only long term patients already enrolled

in their program so they have very clear records of

their patients pre- and post- treatment status. 90

Kings County alcoholism clients have been referred to

acupuncture because of frequent positive breathalyzer

tests and recurrent need for in-patient detoxification.

60 of these patients have not had a positive breathalyzer

test since their first day of acupuncture! Testing is still

done three times weekly. Most of the clients discontinue

frequent acupuncture treatments after several months

but they continue to attend therapy and testing. These

acupuncture clients — prior misfits — have become

leading sobriety role models in the alcoholism counseling


The alcoholism program in Hennepin County (Minneapolis)

has treated 120 severe, chronic alcoholics in their acupuncture

program. About 20% have stayed sober for six months and

55 percent have shown marked improvement. A previous

study comparing sensitive acupuncture points to placebo

points also showed impressive evidence that acupuncture

treats alcoholism effectively.

The international community has responded favorably.

So far, visitors from 35 foreign countries, including a

United Nations director, a World Health Organization

representative, and government officials from Asia,

Europe and the Caribbean, have come to the South

Bronx to observe and learn from our experience.

Acupuncture detoxification clients at Lincoln include

abusers of alcohol, heroin, cocaine, methadone,

sedatives, stimulants, and hallucinogens alone or in

combination. Some of these patients have a primary

psychiatric diagnosis, and others have psychotic toxicity

resulting from acute and chronic drug use. The following

examples illustrate the challenge of treatment that we

have accepted.

Difficult Intakes

We have many intensely disturbed people who come to

our building for help. One 42 y/o man, A.B., had pages of

the bible taped to his chest, and had a large knife extending

out of his pocket. He was currently sober but had been

referred by a local hospital for alcoholism treatment. As

we hesitantly spoke to A.B. in the acupuncture area, he

turned his head around and asked "can I get some of

this?” We were surprised at his interest but administered

ear acupuncture treatment. A.B. slept for a while and 20 National Acupuncture Detoxification Association

then was quite willing to be accompanied to a hospital

emergency room for admission.

F.C. is a 23 y/o woman who abused PCP and various

prescription drugs. She was reported to the Bureau of

Child Welfare for placing her infant child in the oven.

F.C. had been hospitalized in an in-patient psychiatric

unit for 3 weeks with no engagement in therapy. She

had been very rude and negative toward any type of

outpatient follow-up. As she left a social worker's office,

F.C. accidentally caught a glimpse of the acupuncture

treatment area. She pointed to the room where dozens

of patients were sitting quietly alone and said I’ll take

that kind of treatment." F.C. had many scars and tattoos

on her body. She was quite self-conscious, often behaved

in a bizarre manner, and continued to drop hints about

feeling suicidal. At first she flinched when taking the

acupuncture and for a time she wanted to leave the

room before the relaxation effect became operative.

Throughout her course F.C. was reluctant to establish

any regular verbal relationship. She often tried to provoke

the hospital police into expelling and hurting her. In the

spring of 1983 F.C. received acupuncture treatment for

56 days consecutively. She felt comfortable enough to

fall asleep with the treatment only on Sunday--when the

clinic was quite empty. Subsequently, without telling us,

F.C. located a psychiatric day hospital in another part of

the city and became a patient there for several months.

F.C. has given us numerous clean urines recently.

Acupuncture helped her face the need for psychotherapy

in a productive manner.

We have treated many patients who were brought in

by their families with acute psychosis from cocaine or

PCP. The initial acupuncture treatment is usually able

to calm these patients so that they do not need to be

hospitalized and are motivated to return for acupuncture

and counseling on the next day.

Paranoid And Homicidal Behavior

H.W. came to our clinic in September 1984 with a

drug habit and an obviously paranoid condition. He

had a history of LSD psychosis in 1972 and at least 3

state psychiatric hospitalizations. H.W. was evidently

hearing voices and reported bizarre somatic delusions.

H.W. attended acupuncture 5-6 days a week for the

next 6 months. After the first day he said that his voices

“went away.” Use of heroin and cocaine continued

intermittently. H. W. was so guarded that no individual

verbal sessions were attempted until April 1985. H.W.

is now readily communicative, working part-time, and

attends acupuncture weekly. We have consistently been

able to stabilize chronic paranoid patients even those

with active hostility and a history of violence.

D.G. is a 36 y/o man who requested treatment for

"anxiety" in 1984. He had used heroin in Vietnam and

the U.S., and has remained on methadone maintenance

for 5 years as well as abusing pills and alcohol. D.G. said

he enjoyed killing in Vietnam and had several weapons

in his house. During the first months of treatment he

usually entered the clinic in an aggressive manner. He

was frequently high and perspired actively. Often when

acupuncture was administered, he would recede into a

state of calm detachment. D.G. was more lonely and

intolerant of relationship than most of our patients.

He began to attend acupuncture daily, tapered his

methadone dose, and markedly reduced his pattern of

alcohol and pill abuse. He attempted to offer gifts to

clinic staff members. In May 1985 D.G. located and

obtained a job offer with a utility company. This patient

required many months of acupuncture treatment,

punctuated by various crisis encounters before he was

able to participate in constructive verbal interchange

with our staff. D.G. had not been helped by methadone

and his manner was so disruptive as to preclude other

forms of treatment. Acupuncture seems to have been the

only path to reach this homicidal person and begin the

process of rehabilitation.

Support For Other Therapy

R.R., referred by a family court social worker, had a

long record of alcoholism and child abuse. She had been

attending therapy sessions weekly for the past year with

no change in her behavior. R.R. was labeled a poorly

motivated patient. After the first week of acupuncture, her

children and neighbors came to the clinic and reported a

very agreeable change in her behavior. R.R. said this time

the impulse hadn't been as strong and she “had been

able to remember what her therapist had told her." This

patient had not been poorly motivated; she had attended

weekly sessions even though there had been no progress.

She did not have a poor memory; on the contrary she had

been distracted from remembering effective suggestions

by an impulse disorder and alcohol abuse. R.R. only took

acupuncture for 2-3 weeks nevertheless the treatments

helped her use the therapy sessions more effectively so

that the past year's effort was not wasted. The court

agency reports R.R. continued therapy for a while and

no longer shows a tendency toward child abuse.National Acupuncture Detoxification Association 21

Management Of Violence Between

Clinic Patients

K.D. had been a patient in our alcoholism program

before serving 2 ½ years in jail. He was a bizarre, visibly

troubled 40 y/o man who was quite socially isolated.

K.D. stabbed one of our other patients, F.P., away from

the clinic site in 1984. K.D.'s parole officer was not able

to return him to prison and was not able to transfer him

to another treatment program. K.D. had such a troublemaking

reputation that he was rejected by wardens and

clinicians alike. K.D. and F.P. often received acupuncture

in the same room simultaneously. Both relaxed easily

with the treatment. There was never a hint of any

disturbance. K.D. has experienced substantial periods of

sobriety in 1985. His mind has become so much stronger

and clearer that he has been able to be interviewed by

clinicians visiting our facility.

Usually the possibility of violence between patients would

paralyze the treatment process. Acupuncture has helped

us treat clients within their existing environment of

social turmoil. It is much too expensive and impractical

to institutionalize every troubled violent person in a

city such as New York. As a society we must develop

community-based methods of coping with widespread

substance abuse and violence.

Staff Attitudes And Strengths

Clinical staff who work with acupuncture detoxification

patients understand the special opportunities and

requirements that we have described in this paper. They are

able to foster autonomy and work in a calm atmosphere.

Flexibility and tolerance of failure are important so that the

staff person can work with recently relapsing clients. Skills

involving touching and other non-verbal support are also

valuable in this setting. Staff members who use relatively

authoritarian, judgmental or guilt-producing techniques

do not adjust well to the necessarily gentle and permissive

atmosphere of an acupuncture detoxification setting. In the

large group setting we do not emphasize authority symbols

such as desks and signs. The patients are able to watch the

acupuncturists and counselors work so that they can feel like

they are participating in the treatment procedure.

Many substance abuse clients are obsessed with guilt and

self-deprecation. They must try to learn not to link every

withdrawal symptom and craving with psychological

issues. Even though substance abuse is an overall psychosocial

matter, it is not helpful to psychologize every step

of the detoxification process. When a detoxing client

starts to cry, teach them not to ask or worry about the

"cause" of the tears. Clients should expect to face the

psycho-social problems gradually as they gain strength

and after the basic cleansing and balancing process.

Our patients are usually unable to tolerate intense one-toone

relationships. We disarm them by coping with their

turmoil in a non-attached, gentle manner. This form of

interaction protects the patient from their own feelings

of inadequacy and allows the gradual development of a

relaxed, flexible basis for their personality. The relaxation

effect of acupuncture is not comparable to the sedative

effects of drugs. Acupuncture helps the body develop a

healthy neutral state similar to that of meditation or yoga.

This condition leads to healing and growth, not merely the

control of symptoms. In Chinese medicine the lack of 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 false fire (Xu huo) that

many addicts present and to conclude that the main goal

should be sedation of excess fire. In fact the addict himself

takes this approach in the extreme by use of sedative

narcotics. The hostile, paranoid, hustling climate of our

inner city communities exemplifies an energy-depleted

condition with false fire burning out of control. Our

patients seek greater power and control over their lives.

The empty fire condition represents the illusion of power.

An illusion that leads to more desperate chemical abuse

and senseless violence. Acupuncture provides an effective

treatment for these empty fire conditions. The patient is

empowered, but in a soft and easy manner.

Let me conclude by describing the cheerful and cooperative

atmosphere that acupuncture detoxification engenders.

We are a crowded walk-in clinic in the South Bronx, one

of the poorest sections of the city. Our former methadone

component was always filled with argumentative and

hyperactive behavior. The acupuncture component has

always had a calm and cooperate atmosphere even though

it was staffed by precisely the same people in the same

confines. In addition to detoxification clients, we have

numerous general medicine acupuncture clients who

receive treatment in the same settings. Visitors to our

clinic see middle-aged housewives, young professional

people and working class people--all sitting side by side

together with many substance abusers in a harmonious

atmosphere. Social bonds become re-established because

the treatment modality does not further isolate


The crack/cocaine epidemic raging in this country

has evoked one hopeful response from an otherwise

overwhelmed treatment community: a renewed interest

in acupuncture treatment, for detoxification, preparation

for counseling, and relapse prevention.

Usually administered in an outpatient setting, with

needles inserted on the outside of the ear — therefore

the term "auricular" — auricular (ear) acupuncture is an

accessible treatment which allows individuals to withdraw

from drugs and/or alcohol and to pursue recovery

without having to leave their families, equipping them

to maintain abstinence in the face of everyday pressures.

Acupuncture is a valuable entry point for chemical

dependency treatment and provides a bridge from active

substance abuse to readiness for counseling and other

support services via its calming and focusing effects.

Acupuncture Treatment for

Chemical Dependency

Developed by the Chinese more than 2500 years ago,

acupuncture is a technique to relieve pain and stress by

inserting needles into specific points on the body believed

to correspond to structures and functions within the body.

Auricular acupuncture was first applied as a treatment for

opiate addiction in 1972 by H.L. Wen, M.D. in Hong

Kong (Smith & Kahn, 1988; Wen & Chueng, 1973).

Acupuncture procedures based on Wen's initial protocol

which used electroacupuncture on two ear points

have become varied and diverse. Different numbers

of acupuncture points and types of stimulation have

been used. These include needling with and without

electrical stimulation, surgical staples or tacks, and

transcutaneous electrical nerve stimulation (TENS)

using surface electrodes without needles (Katims, Ng &

Lowinson, 1992). Although ear points have been used

predominantly, body points have been used as well.

Lincoln Clinic

Acupuncture detoxification was first used on a large

scale beginning in 1974 at Lincoln Clinic, Bronx, New

York. The community sought an alternative to straight

methadone detoxification. Acupuncture promised an

alternative to the "demoralizing and stupefying effects of

trying to solve a problem of drug abuse by administrating

more abusive drugs" (Smith, 1979, p. 98). When

acupuncture was first introduced into the program,

the protocol established by Wen was followed using

electroacupuncture. Budgetary restraints preventing

replacement of broken equipment and an extended

power shortage led to the discovery that manual needling

on auricular acupuncture points was more effective

than electroacupuncture. It was more successful, easier

to administer, and less expensive. Lincoln Clinic has

continued to use manual acupuncture and has developed

a standardized three to five point protocol that is the most

commonly used treatment protocol (American Hospital

Association [AHA], 1991).

Auricular points (kidney, liver, lung, sympathetic and

shenmen) located on the outer ear are manually stimulated

with half inch stainless steel sterile/disposable needles

which remain in place 45 to 60 minutes. In the case of

pregnant women, only three points are used: liver, lung and

sympathetic. Treatment is administered to clients seated

in a quiet group setting. Withdrawal symptoms gradually

improve within 15 minutes. Patients initially receive daily

treatment for two weeks, then decrease the frequency.

After a treatment session, patients seem more alert, relaxed,

and report the ability to think clearly. They also tend to be

more verbal. These effects last from many hours to several

days, depending on the severity of addiction. Once beyond

the immediate symptoms of withdrawal, they receive

regular counseling and are encouraged to attend 12-step

meetings. Daily urine samples are collected. The cost per

patient averages $21 per treatment including counseling

and urinalysis (AHA, 1991).

National Acupuncture

Detoxification Association

A non-profit organization has been established to

teach and annually recertify practitioners who utilize

the auricular acupuncture detoxification protocol

developed at Lincoln Clinic. The National Acupuncture

Detoxification Association [NADA] is known by the

acronym NADA, which means "nothing" in Spanish

and symbolizes the commitment to a drug free response

to addiction. NADA consults with communities and

other groups interested in starting similar treatment

programs, provides training and certification in the

treatment protocol developed at Lincoln, and provides

cross training for chemical dependency specialists and

acupuncturists to enhance treatment collaboration.

Since the founding of NADA anecdotal reports on the

application of NADA protocol acupuncture have been

consistently encouraging (Smith & Kahn, 1988). More

than 100 publicly funded clinics in 14 states and another 24 National Acupuncture Detoxification Association

25 in Europe, Eastern Europe, Latin America and Asia

have been established explicitly on the model of the

South Bronx clinic (AHA, 1991). The treatment settings

are diverse and include psychiatric outpatient clinics,

chemical dependency inpatient and outpatient programs,

homeless shelters and criminal justice settings (Pittman,

1992; Smith, 1987; Smith, 1990; Smith, Alvarez &

Small, 1987; Smith & Kahn, 1988).

Acupuncture Treatment for Pregnant

Substance Abusers

Since 1974 more than 1000 pregnant women have

received manual auricular acupuncture, without

incidence of uterine seizures or spontaneous abortion

(M. O. Smith, personal communication, November

23, 1990). Ignorance about acupuncture leads many to

assume that any acupuncture treatment administered

during pregnancy places the fetus at risk (Becke, 1988).

In fact, acupuncture has been used for thousands of years

to treat morning sickness, premature labor, malposition

of fetus, toxemia, and labor pain (Academy of Traditional

Chinese Medicine, 1975; Shanghai College of Traditional

Medicine, 1981). Electroacupuncture is contraindicated

during pregnancy, however manual stimulation of

acupuncture points has long been used beneficially for

conditions related to pregnancy.

Lincoln Clinic has treated more than 750 pregnant

women since 1988 in its special program for pregnant

substance abusers (N. Smalls, personal communication,

February 23, 1991). The program combines the services of

an obstetrician-gynecologist, psychiatrist, acupuncturist,

and nurse-midwife as well as counseling support staff

(Smith, 1988, c; Smith, 1990c). Similar programs have

been established in many locations in the United States

and abroad.

By providing supportive acupuncture during the process

of gradual reduction of the use of addictive substances, this

treatment mitigates elements of drug and alcohol withdrawal

during pregnancy which may be damaging to the mother

and/or infant such as seizures (Fitzgerald, 1988).

Acupressure for Newborns and Infants

Babies exposed to drugs during gestation have been

treated with acupressure with dramatic success (Keenan,

1990). The infants were treated for withdrawal symptoms

with acupressure to the outer ear. Herbal seeds (semen

vicarae) were taped to one to three ear points specific

to addiction and selected according to the degree of the

infants' development. The mothers and/or other care

givers were instructed to press the seeds several times a

day. In this way the mother could contribute directly

to the recovery of her baby. This procedure afforded an

opportunity to address maternal guilt about having used

substances during pregnancy. By relieving withdrawal

symptoms and reducing the "dulling" seen in substance

affected newborns, acupressure stimulation enhanced

"focusing" and maternal-infant bonding. Acupressure

may be an important tool to assist the newborn through

the neonatal abstinence syndrome and should be

evaluated as soon as possible. Now widely described as

"seed therapy" this method of treating infants is being

used in many locations in this and other countries (P.

Keenan, personal communication, August, 1992).

Methadone Treatment

Methadone, a synthetic opiate which decreases the

craving for heroin, is commonly recommended for all

heroin addicts including pregnant addicts in spite of its

known toxic effects (Finnegan, Connaughton, Emich &

Wieland, 1972). A dose level of 20 milligrams (mg) or less

per day is currently recommended to avoid teratogenic

effects (Kosten, 1989). In practice, pregnant women are

regularly maintained on doses of 40 mg or higher.

The addict who is detoxified from heroin, even if

maintained on methadone, is very likely to increase his

or her use of alcohol and/or cocaine (Anglin, 1989) or to

continue to use heroin and/or larger doses of methadone.

Studies have shown that half of all addicts on methadone

maintenance test positive for other substances of abuse

and more than 50% of methadone maintenance clients

typically drop out of treatment (Clark, 1990). One

obvious problem with methadone treatment is that

only one substance, heroin, is being addressed. This is

problematic, since most addicts are polyabusers (Lipton

& Miranda, 1983; Zuckennan & Alpert, 1988).

Acupuncture has been found to be as clinically effective

and more cost efficient than methadone treatment (Clark,

1990). Acupuncture relieves withdrawal symptoms for

all substances of abuse simultaneously. "Acupuncture

relieves withdrawal symptoms and craving, promotes

general relaxation, systemic rebalancing, and enhances

mental and physical functioning" (Smith & Kahn, 1988).National Acupuncture Detoxification Association 25

Current Therapies for Addiction

Numerous therapies for addictive problems exist, each

claiming success (Frances, 1989). The cost effectiveness

and accuracy of these claims is questionable and generates

much debate in the field of chemical dependency (Shaffer,

1986). Rival positions from inpatient as opposed to

outpatient settings (Hayshiada et al, 1989) and from 12-

Step and social-model to aversion therapy claim success.

However, they are difficult if not possible to compare

because there is no uniformity in standards for outcome

measures (Frawley, 1990). For a comprehensive overview

of current therapies see Donovan and Marlatt (1988) and

Lowinson, Ruiz, Millman and Langrog (1992).

According to Trachtenberg and Blum (1989), therapeutic

approaches can be categorized as follows: (1) traditional

verbal psychotherapy and/or 12-Step group processes,

education and activity; (2) medication or neurochemical

support with little education or therapy; (3) Verbal

therapy with medication; and (4) aversion therapy, with

or without medication.

In the first category, most are inpatient programs which

had typically scheduled for thirty days, the amount of

time previously supported by insurance. Recently, the

average length of stay funded by insurance has been

reduced to five to ten days. These programs typically

require that the client complete detoxification before

admission. Such detoxification is usually medication

based, using a three-day inpatient protocol which entails

sedation. Whether 28-day inpatient programming is

more successful than other methods is doubtful since it

is estimated that 40-50% of alcoholics are believed to

relapse within a one year and 50-80% of cocaine abusers

relapse in the first year (Gawin & Ellinwood, 1988). The

effects of psychotherapy have been favorably reported in

spite of conflicting outcomes in studies of opiate addicts.

See Kaufman and McNaul (1992) for a thorough review

of recent findings.

Medication and/or neurochemical support modalities

with minimal education and counseling comprise the

second category. The chemical agents utilized include

antidepressants, neuroleptics, anti-Parkinson agents, and

amino acids. Trachtenberg and Blum (1988) reviewed the use

of antidepressant medication and concluded that generally

antidepressant medications have not been significantly

successful in preventing relapse to cocaine addiction.

Although researchers are clearly looking for “cocaine's

methadone" (Scientists say .... , 1993) the search for cocaine

antagonists has not been successful (Gawin & Kleber,

1986; Kosten, Kleber & Morgan, 1989). Medications are

prescribed for cocaine withdrawal to ward off a cocaine

"crash." Problems stemming from these medications are the

generation of side effects and the risk of drug dependence.

Studies in this area have shown inconclusive outcomes

(Cosser, Brower & Bresford, 1990; Dackis & Gold, 1985;

Dakis, Gold, Sweeney, Byron & Climko, 1987).

Whether medication is really necessary during withdrawal

from a variety of substances is itself controversial. For

example, in a report on cocaine treatment in 12-month

follow up study (Summer, 1990) cocaine withdrawal

without medication was found successful.

Alternate therapies including acupuncture are

incorporated in the category of neurochemical support.

This would also include modalities such as biofeedback,

Vitamin C therapy and amino acid supplementation.

A summary of alternate modalities can be found in

Lowinson, Ruiz, Millman and Langrod (1992), Kleber

(1977), Kleber and Riordan (1982).

In the third category, verbal therapy plus medication and/

or nutritional and neurochemical support modalities,

psychotherapy alone was found to have disappointing

results: only 17% of the group studied were able to

abstain and improvement was limited to only half of the

group (Gawin and Kleber, 1986).

Aversion therapy with and without medication and/

or nutritional and neurochemical support is the final

category. Usually administered in a two week inpatient

setting, there has been controversy regarding the claims

for its success (Barbor, Stephens & Marlatt, 1987).

Theories of Addiction

While the issues regarding conditions which increase

risk for substance abuse such as poverty, unemployment,

severe deprivation in childhood, and physical and sexual

abuse all need to be addressed (Hellert, 1988), it is not

within the scope of this overview to do so. However,

many theoretical models have been created to explain

the phenomena of addiction and heavy drinking. These

theories include anthropological, availability, conditioning

aversion, economic, genetic, neurobehavioral,

neurobiological, personality, psychoanalytic, social

learning and social systems (Chaudron & Wilkinson,

1988; Fingerette, 1988). An excellent summary of these

and other theoretical models can be found in Chaudron

and Wilkinson (1988).26 National Acupuncture Detoxification Association

Biopsychosocial Theory

Although this literature review is focused primarily on

detoxification and prevention of relapse on a physiologic

basis during pregnancy, thus falling into the category of

neurobiological theory, the theoretical model that more

accurately applies to the, phenomenon of acupuncture

detoxification is the biopsychosocial model (Wallace,

1989). As the name implies, the biopsychosocial theory

suggests that this illness involves biological, psychological

and sociocultural factors. For a comprehensive discussion

of the implications of this model, see Donovan (1988).

The value of acupuncture as a preparation for psychological

and social change has been suggested by clinicians (Clark,

1990; Kao & Lu, 1974; Newmeyer, Johnson & Klot,

1984; Smith, 1988a; Smith, 1988c; Smith, 1989b; Smith,

1990a). It is essential that social and psychological aspects

in addition to neurobiochemical issues be addressed both

theoretically and clinically to obtain maximum results

in chemical dependency treatment. Acupuncture is best

understood as an entry point into a larger system of

recovery that requires psychological and social change to

prevent relapse. Further research regarding these aspects

related to acupuncture detoxification is needed.

Genetic Theory

Support for studies on the genetic and biological basis

of alcoholism has increased from $41 million in 1989 to

$53 million for 1991 (Goleman, 1990). Researchers have

identified a gene linked to the receptors for dopamine, a

brain chemical involved in the sensation of pleasure. In

the chronic alcoholics autopsied in the study, 77% were

identified as having this genetic marker compared to

none of the controls (Blum, 1990a; Blum et al, 1990b).

Research on alcoholism also suggests that imbalance

in the brain's receptors for the neurotransmitter

gamma-aminobutyric acid [GABA] result in increased

anxiety; the less GABA present, the greater the anxiety.

It has also been shown that sons of alcoholic fathers

had lower levels of GABA and higher tension levels

than men whose fathers were not alcoholic. When

given a glass of vodka, the GABA levels of the first

group rose to levels equivalent to those of controls

and their tension levels declined. It was hypothesized

that GABA irregularity is a trait marker link to the

genetic vulnerability for alcoholism (Blum, 1990b).

Genetic research relevant to drug abuse is just

beginning to be studied in five critical areas: animal

selective breeding studies, adoption studies, twin

studies, family studies and high risk situations. See

Kaufman & McNaul, (1992) for a thorough review.

Neurobiochemical Theory

A neurobiochemical theory illustrating cocaine dependency

suggests that the stimulating effects of cocaine are the result

of its potentiation of the catecholamine neurotransmitters

norepenephrine [NE] and d-phenelalynine [DA]

(Trachtenberg & Blum, 1988). To understand how this

addiction model works, it is first necessary to understand how

brain neurotransmitters normally operate.

Cells using NE and DA as neurotransmitters occur

in discrete locations in the brain stem and project to

higher brain areas including the basal ganglia (effecting

motor dysfunction), limbic system (effecting arousal

and basic appetite drives and aggression), and

hypothalamus (effecting hormone function). These

diffuse projections of nerve cell axons contribute to

the general state of arousal. These neuronal systems

exert their effects by releasing DA or NE into the

synapse, the very narrow space between the neurons.

Once released into the synapse, the neurotransmitter

interacts with specific DA or NE receptors on the next

neuron to exert central physiological effects. Under

normal conditions, DA or NE is rapidly removed

from the synapse by an uptake mechanism, resulting

in the neurotransmitter having a brief pulsatile effect

on the target receptors (p. 5).

Cocaine has powerful effects on the DA and NE synapses

and inhibits the reuptake of DA and NE (Gawin, 1988).

By blocking the normal mechanism, the impact of these

neurotransmitters is increased many times over. Instead

of the brief pulse of transmission there is continued

stimulation which is associated with cocaine intoxication.

Serotonin is a neurotransmitter providing many

functions including arousal, mood, and endocrine

regulation. Repeated use of cocaine effects the serotonin

system by reducing the concentration of serotonin

and its metabolytes (Gold, Washton & Dackis, 1985).

Recidivism may reflect adaptive, long lasting central

nervous system [CNS] change which physiologic

withdrawal fails to reverse (Katims, et aI, 1992).

With this in mind, the impact of acupuncture on the

process of addiction may be better understood.National Acupuncture Detoxification Association 27

Theory of Acupuncture Detoxification

Western Medicine Model

Kroening and Oleson (1985) offered this succinct

description of the neurochemical theory of acupuncture


The mechanism by which the acupuncture effects

withdrawal from narcotic addiction is not yet fully

understood but similar theories have been proposed

by several observers ... .In drug addiction exogenous

opiates bond with receptor sites normally occupied

by endogenous endorphins. The occupation of these

opiate receptor sites by narcotic drugs leads to the

inhibition of natural endorphins while the body's

own internal mechanisms oppose the external drug

therapy, resulting in intolerance and addiction.

Abrupt withdrawal from the exogenous drug leaves

the body's defense mechanism still geared to offset

the narcotic action. Acupuncture may facilitate

withdrawal by activating the release of previously

suppressed natural endorphins which can then

occupy the receptor sites formally dominated by the

narcotic drug (p. 5).

Western medicine has been reluctant to accept

acupuncture (Diamond, 1971; Kroeger, 1973; Lau,

1976; Moyers, 1993), although basic science research has

documented the phenomenon. Recordings have been

made of the electrical flow along the meridians (Becker

& Selden, 1985) energy flow along the meridians

(Dumitrescu & Kenyon, 1983), and radioisotope flow

along meridians (Darras & De Vemejoul, 1986). The

physics of Chi energy continues to be researched in the

West (Fetzer, 1989; Navach, 1989).

An increasing number of physicians outside of China are

using acupuncture to treat chronic pain. Approximately

50,000 physicians in Germany, 30,000 in France, and

60,000 in Japan use acupuncture along with drugs,

nerve blocks, and other approaches to treat patients with

chronic pain. The numbers are much lower in Great

Britain and North America, but have increased since the

discovery of the acupuncture-endorphine relationship

which provided evidence for the neurochemical theory

of acupuncture (Pomeranz, 1987).

As early as 1973, Lei had proposed the neurological

basis of pain and its possible relationship to acupuncture

analgesia. Omura (1976, 1978) demonstrated the

pathophysiologic mechanisms of acupuncture while

Jacobs, Anderson, Bailey, Ottaviano and McCarthy

(1977) described the analgesic phenomenon in the

limbic and thalmic responses in the brain. Wen and

his associates conducted a series of studies which also

demonstrated the connection between acupuncture and

neurotransmitters (Wen, 1977 ; Wen, 1980; Wen et aI,

1978; Wen et al, 1979; Wen, Ho, Ling & Choa, 1979).

A rise in levels of endorphins in human narcotic addicts

was shown as early as 1979 (Clement-Jones et al).

The work of Pomeranz and Chieu (1976) provided early

evidence of the endorphin mechanisms in acupuncture.

Mice, given electrical stimulation at "real" acupuncture

points, exhibited higher pain thresholds than mice

given "sham" electroacupuncture-stimulation of nonspecific

points. When "real" acupuncture was followed

by naloxone--an opiate antagonist-- the analgesic effects

were absent, while powerful analgesic effects were

found when electroacupuncture was followed by saline

(Kroening & Oleson, 1985).

There is a growing body of scientific evidence to explain

the behavioral and physiologic effects of acupuncture

(All China Society of Acupuncture and Moxibustion,

1984). Since acupuncture reduces opiate withdrawal

symptoms in rodents (Ng, Donthill, Thoa & Albert,

1975; Ng, Thoa, Donthill & Albert, 1975) these effects

cannot be attributed to suggestibility or placebo effects in

human subjects. The action of acupuncture was described

in a study entitled "Endorphine release: a possible

mechanism of acupuncture analgesia" (Peng, Yang, Kok

& Woo, 1978). This was subsequently documented when

researchers injected brain and blood serum extracted

from rabbits which had received acupuncture into rabbits

which had not been acupunctured (Wu & Hsu, 1979).

This produced a marked analgesic effect on the recipient

rabbits as shown by a significant increase in their pain

threshold. The effect was counteracted by naloxone. It

was then hypothesized that the release of endorphins is

increased by acupuncture stimulation, thereby inhibiting

pain. This is similar to the reciprocal relationship between

heroin and naloxone.

Electrical stimulation at acupuncture body points has

been shown to release endorphins and enkephalins in

animals (Pomeranz, 1981). Studies have indicated that

serum ACTH and cortisol levels were significantly

reduced in human addicts after acupuncture treatment

(Wen et al, 1978). Similarities between the mechanisms

of acupuncture and morphine analgesia have also been

shown (Han, Li & Tang, 1981).

In 1979, endorphin levels were directly measured

during acupuncture, demonstrating the elevation

of endorphins in cerebral spinal fluid (Han, Tang, 28 National Acupuncture Detoxification Association

Huang, Liang & Zhang, 1979). Cheng and Pomeranz

(1979) demonstrated that amino acid and acupuncture

produced greater analgesia than either treatment alone

and naloxone reversed those effects.

Similar findings have been demonstrated regarding the

release of endorphins in humans following auricular

acupuncture (Pert et al, 1981). This evidence supports

earlier findings that the blockade of the analgesic effect of

acupuncture by naloxone establishes the relationship of

acupuncture to the endorphine system (Liao, Seto, Saito,

Fugita & Kawakami, 1979; Mayer, Price & Raffi, 1977;

Peets & Pomeranz, 1978).

Oriental Medicine Model

Acupuncture is part of an Eastern tradition which embraces

a systemic/holistic perspective (Macek, 1984; Mann,

1973). Drug dependence is seen as a symptom of a system

or society which is out of balance. For a comprehensive

overview of the philosophical and historical context of

Oriental Medicine, see The Web That Has No Weaver

(Kaptchuk, 1983).

The mechanisms of acupuncture detoxification from

the perspective of Oriental Medicine can be described

metaphorically. The lack of inner calm tone due to intense and

frequent use of chemical substances is described as a condition

of "empty fire" (Smith, 1985) wherein heat of aggressiveness

overcompensates and the calm inner tone is lost.

It is easy to be confused by empty fire and to conclude

that the main treatment goal should be sedation of

excess fire. Addicts themselves take this approach to

the extreme by using sedative drugs. The empty fire

condition represents the illusion of power, an illusion

that leads to more desperate chemical use and senseless

violence. Acupuncture helps patients with this condition

by stimulating "yin" points to restore inner calm tone

(Smith & Ra,1985). "Patients often consider these

prolonged symptoms as permanent results of their past

activities. They are amazed that fresh, clear, youthful life

is still possible" (Smith, 1985, p. 3).

According to Traditional Oriental Medicine, the same

acupuncture points seem to be effective for various

substances of abuse suggesting that the critical energy

disturbance is similar regardless of the substance of abuse

(Smith, 1989b).

The procedure of stimulating points on the external ear

links the ear which is shaped like a fetus or a kidney to

kidney function. Frequent repetition of kidney-related

ear (auricular) treatments works even with severely

debilitated alcoholics and addicts. When the kidney

energy has been damaged, the recovery period is slow

and undulating in intensity. Even patients with severe

paranoia respond well to this protocol. Paranoia involves

fear — a kidney related and yin depleted emotion — and

a hollow, aggressive ego structure that is an expression

of empty fire. The more desperate antagonistic patients

who have suffered more yin depletion seem to benefit

most from these treatments. "In addition, many socially

functioning empty fire patients who may or may not be

abusers benefit greatly from these treatments" (p. 2).

Patients with moderate chemical dependency or who have

completed most of their recovery from severe addiction do

not respond as well to the kidney-ear protocol alone and

often need additional body point acupuncture according

to the conventional principles of Chinese medicine. The

distinction of treatment protocols between moderate

and severe abusers is critical. Smith observed (1985) that

severe abusers are most in need of better health care and

are most resistant to virtually all forms of intervention.

By strengthening the kidney, these deficient patients are

rehabilitated to return to the commonly expected level

of yin function. Severely addicted clients need auricularkidney

treatment before they are able to respond to

other forms of acupuncture or psychological and social


Acupuncture Detoxification Studies

Anecdotal Reports and Clinical Trials

The usefulness of auricular acupuncture to reduce

withdrawal symptoms during opiate detoxification

was accidently discovered in 1972 by H.L. Wen (Wen

& Cheung, 1973). While administering auricular

acupuncture for pain control to a surgical patient who

was an opiate addict, the patient reported relief from

opioid withdrawal symptoms (Katims et al, 1992).

Wen then studied forty opium addicts who were treated

with electrostimulation of the lung points on both

ears. Sessions ran 15-30 minutes, two or three times

a day for the first two or three days and once daily for

the next four to five days. Patients were freed of most

of the characteristic symptoms of withdrawal such as

irritability, runny nose, nervousness, aching bones, and

cramps. They were discharged after eight days. Standard

medical practice at that time was to gradually withdraw

addicts over a three to five month period to prevent

occurrence of withdrawal symptoms (Kleber, 1977).

Abrupt cessation of opiates — kicking the habit cold National Acupuncture Detoxification Association 29

turkey — takes several days and is usually accompanied by

severe flu-like symptoms (Whitehead, 1978). Therefore,

the 8-day length of treatment time was not by itself

remarkable. However, of the 22 patients for whom urine

samples were available, only two were positive for heroin

at follow up. These urine sample results were remarkable

as was the observation that craving for opium ceased after

acupuncture stimulation.

 The discovery that acupuncture with its 3000 year

history now had a new application coincided with the

several events that marked the opening of the United

States to acupuncture. President Richard Nixon travelled

to China in 1972. The work of the French physician, Paul

Nogier who developed the technique known as auricular

medicine utilizing acupuncture points on the ear became

available in English. Nogier's discovery of auricular

medicine had reached China and was substantiated and

embraced there (Kenyon, 1983; Nogier, 1983). The "war

on drugs" under Nixon was initiated, focusing on "the

heroin plague" (Ford-Geiger, 1986).

The reaction to the news of acupuncture as a treatment

for heroin addiction was mixed: enthusiasm from those

who projected a cure for heroin addiction (Patterson,

1974, 1976), curiosity (Lau, 1976) and wide spread

skepticism (Whitehead, 1978).

Following the initial studies by Wen, there were many

anecdotal reports of auricular electroacupuncture for

detoxification from settings world-wide: Australia (Sainsbury,

1974), Canada (MacQuarrie, 1974), Great Britain (Patterson,

1974, 1976), Italy (Cocchi, Lorini, Fusari & Carrossino,

1979; Lorini, Fazio, Cocchi, Fusari & Roccia, 1979),

Malaysia (Heggenhoughen, 1984), Mauritius (Shaowanasai,

1975), Pakistan (Shaiub, 1976), Southeast Asia (Spencer,

Heggenhougen & Navaratam, 1980), Thailand (Shaowanasai

& Visuthima, 1975), and the United States (Kao & Lu, 1974;

Severson, Markhoff & Chun-Hoon, 1977; Smith et al, 1979-

90; Tennant, 1977).

In an attempt to duplicate the work of Wen and Cheung

(1973), a clinical trial of 23 cases was conducted (Kao and

Lu, 1974). All patients had previously been on methadone

for at least one year and were considered well motivated

to terminate methadone maintenance. Detoxification

treatment included direct needling of auricular points

for cramps, headache, backache, and anxiety. Bilateral

electrostimulation was also applied to the lung and heart

points. After the first few days of treatment, patients

were taught to use the electrical stimulator themselves

and could thus regulate the intensity and frequency of

their own treatments. As was true in most early studies,

treatment was administered in an inpatient hospital

setting. Daily urine testing was done to insure that no

drugs were being used surreptitiously. The procedure was

found to be "extremely successful" (p. 207). However, no

summary data was presented. This research was the first

to elaborate the concern for the psychological and social

aspects required for continued abstinence. The model

proposed a multi-faceted program aimed at helping the

drug addict achieve a "'lasting cure, including a fully

staffed acupuncture clinic to be open 24-hours a day, a

full service rehabilitation center and a 24-hour hotline"

(pp. 207-208).

Other early trials of electroacupuncture included diverse

and contradictory findings. MacQuarrie (1974) reported

the work of L. K. Ding of the Discharge Prisoners

Aid Society of Hong Kong. After several clinical trials

Ding concluded that electroacupuncture by itself was

often not sufficient to relieve withdrawal symptoms.

He used it on a "voluntary basis" for some patients

as well as making it part of his standard treatment in

conjunction with methadone withdrawal. Sainsbury

(1974) reported a detailed case study of an 18 year old

Australian woman withdrawn successfully from heroin

by electroacupuncture.

Patterson (1974, 1976), a British surgeon who worked

with Wen in Hong Kong and returned to London,

observed that electrical stimulation was of greater

significance in the treatment than the needling of

acupuncture points. She continues to work on the

intensity and frequency of the electrical current in

electrostimulation treatment (Patterson, 1991).

The use of electrostimulation has been studied more

extensively than manual acupuncture, although the

latter is more widely used clinically. Researchers using

TENS apparatus for symptoms of withdrawal (Gomez &

Mikhail, 1974; Patterson, 1991; Smith & O'Neil, 1975)

suggest that it is the electrical frequency used during

stimulation rather than the specific acupuncture points

stimulated that has greater medicinal effect (Katims et

al, 1992).

In Honolulu, Severson et al (1977) followed eight outpatient

heroin addicts who were administered electrostimulation

for four to seven days. Five of these clients were successfully

detoxified on a short term basis but only one remained drug

free at four-month follow-up.

In a landmark clinical trial, Wen (1977) treated

51 heroin addicts with the combined approach of

Auricular-Electrostimulation (AES) plus naloxone. He

used the naloxone to flush opiates from receptor sites 30 National Acupuncture Detoxification Association

in the brain, speeding the detoxification process to a

few days rather than the three weeks to six months

recommended in standard methadone detoxification

(Anglin & McGlothlin, 1985). The AES successfully

suppressed withdrawal symptoms. Forty-one of the 51

heroin addicts in the study were successfully detoxified.

This surpassed AES alone and was more successful

than detoxification with methadone. Small amounts of

naloxone could suppress acupuncture analgesia. This

suggested a similarity in the neurochemical sites of action

of acupuncture and heroin, since the pain relief aspect of

both could be blocked by naloxone. Wen hypothesized

that the pain reducing capacity of acupuncture may be

due to the brain releasing endorphins.

Lewenberg (1985) reported a clinical trial on 106

addicts using a combination of treatments. He used

electrical stimulation, TENS and medication with small

doses of antidepressant and Clonidine – a chemical

compound used for treatment of high blood pressure

and other medical problems, which was given only to

severely addicted patients suffering from chills. Fifty-six

attended more than four treatments; 35 of these were

heroin users and 21 were methadone users; 33 of these

stopped or “substantially reduced" their opiate use by the

end of the third week of treatment. Long term recovery

recommendations included psycho-social support and

lifestyle changes. Although this study had no follow-up

and no control group, it has been cited as a rationale

against using acupuncture alone by those more supportive

of using medications to accomplish detoxification.

In his article "Acupuncture and Addiction: An Overview"

Lau (1976) described several addiction treatment programs

in Canada which offered auricular electroacupuncture

detoxification. Although he mentioned seven locations

including several clinics in Toronto and single clinics in

North York, Ontario, and Winnipeg, these were anecdotal

reports of very few cases. Lau also described a film called

"Acupuncture — A Technique for Treating Alcoholism"

prepared by D. Kubitz, a psychiatrist, marketed by Faces

West Productions, San Francisco.

Staplepuncture, a variation of auricular acupuncture

which did not use electrostimulation, was described by

Sachs (1975) and Tennant (1977) of Los Angeles. This

technique involved the placing of surgical staples on the

ears up to six months. Sachs treated 170 cases using the

lung points. Eighteen patients were totally detoxified with

no withdrawal symptoms, 97 patients were detoxified

successfully with minimal remaining symptoms, and 67

patients were unaffected.

A clinical trial that changed the attitude of many Western

scientists was conducted at the University of California,

Los Angeles [UCLA] Medical School, Department of

Anesthesiology Pain Clinic (Kroening & Oleson, 1985).

Chronic pain inpatients who had become addicted to

opioids were rapidly detoxified using both auricular

electroacupuncture and naloxone, the treatment reported

by Wen in 1977. Of the 14 subjects in the study, 12

of them (85%) were completely withdrawn from high

doses of methadone within 2-7 days. These patients

exhibited minimal or no withdrawal symptoms during

the detoxification procedure and remained off narcotic

medication for follow-up periods of over one year.

Although there was no control group, this study showed

a higher success rate than previous studies of methadone

detoxification (Jaffe, 1985; Kleber, 1977). The authors

themselves observed that the subjects studied were

inpatient pain patients rather than street addicts which

may have accounted for the very positive results.

When Lincoln Clinic was still using electroacupuncture,

it reported a study on the largest number of subjects

followed up at that time (Shakur & Smith, 1979). More

than 3,000 outpatient heroin addicts had been treated

by electrostimulation. In follow-up interviews with the

first 200 clients, 80% reported that acupuncture relieved

some withdrawal symptoms. Long term follow-up was

not included.

Smith, Squires, Aponte, Rabinowitz and BonillaRodriguez,

(1982) and Smith and Kahn (1988) reported

that auricular acupuncture without electrostimulation

was successful in the treatment of all substances of abuse

including heroin, cocaine, crack cocaine and alcohol. Most

reports of treatment at Lincoln Clinic have been primarily

anecdotal, such as the following survey results reported in

1982 (Smith, et aI, 1982): (a) 90% relief of symptoms in

acute withdrawal clients following acupuncture according

to symptom surveys; (b) 90% of all detoxification intake

clients returned for further acupuncture treatment with

no ancillary incentives such as other medications, welfare

credit or probation merits; (c) an estimated 60% of all

acupuncture clients receiving the full series of treatments

remained drug and alcohol free for at least several months.

Smith cited budgetary limitations and an ever increasing

patient load as the reasons no formal statistical studies had

been undertaken up to that time. Similarly, Traditional

Chinese Medicine [TCM] resists the investment in Western

style research at the expense of treatment availability

(Ford-Geiger, 1986). In 1990 a placebo control study was

completed at Lincoln demonstrating the efficacy of this National Acupuncture Detoxification Association 31

treatment modality for crack/cocaine addiction (Lipton,

Brewington, & Smith, 1990).

The results of manual auricular acupuncture treatment at

the Hooper Center in Portland Oregon, a county funded

treatment center based on Lincoln Clinic which offers

a full spectrum of inpatient and outpatient modalities

were reported (Lane, 1988). Acupuncture was used as an

adjunct in all phases of treatment. Inpatients receiving

acupuncture had a higher detoxification program

completion rate than those receiving traditional treatment.

Clients interviewed were very positive about remaining

substance free and about the role of acupuncture in their

efforts. They generally reported great relief of withdrawal

symptoms. Acupuncture was also found to be remarkably

inexpensive at approximately $2.00 per treatment when

added to the existing chemical dependency programs.

Acupuncture has been mentioned frequently in overviews

of treatment interventions for addiction. As early as 1974

a letter had appeared in The Lancet describing auricular

electroacupuncture as a possible treatment intervention

for drug addiction (Tseung, 1974). Whitehead (1978)

called for controlled studies and single blind studies

which would allow easier evaluation of acupuncture

treatment in terms of Western medicine. He criticized

the acupuncture clinical trials described up to 1976

for their lack of clarity and follow-up. Lau (1976) in

an overview, "Acupuncture and Addiction,” described

possible mechanisms of acupuncture and encouraged

continued research. Lipton and Maranda (1983)

suggested acupuncture detoxification as an entry

point to methadone maintenance. Other overviews of

treatment which included acupuncture suggested further

investigation (Colvin, 1983; Katmins et al, 1992; Kleber

& Riordan 1982; Resnick, 1983).

Auricular acupuncture detoxification has been recognized

for its value in AIDS prevention (Konefal, 1989) and

appears in a summary of available treatments (Citizens

Commission on AIDS, 1989). The Family Therapy

Networker featured acupuncture in an issue devoted to

the crack epidemic (Morley, 1990).

Many feature stories on acupuncture treatment for

chemical dependency have appeared in the lay press

and on television. Most of the coverage has focused on

Lincoln Clinic. Under the leadership of Michael Smith,

M.D., current director of Lincoln Clinic, the program

has become a large scale treatment provider and the

model for other program throughout the United States

and abroad (Lane, 1988; Smith, 1987).

Comparison Studies

Although eagerly examined by a treatment community

desperate for a cure for opiate addiction, the shortcomings

of the initial report by Wen and Chueng (1973) are

representative of the conceptual flaws which continue

to plague the literature on acupuncture detoxification.

The first report was criticized as "an inadequate and

inconclusive clinical trial that suggested a need for

further research" (Whitehead, 1978, p. 9). Measured by

Western scientific research standards, the following were

lacking: (a) there was no control or alternate treatment

group; (b) follow-up beyond discharge was unclear, (c)

the difference between a "cure" as opposed to reduction

of withdrawal symptoms was unclear, (d) severity of

addiction (how much, how long), and (e) substances

abused (opium vs. heroin vs. alcohol) were unclear, (f)

placebo tests had not yet been done; and (g) there was

no comparison of points used. The first and last two

issues have been addressed in subsequent research on

acupuncture detoxification. The other issues are the same

as the methodological problems that need to be addressed

in the field of chemical dependency research in general.

Wen and Teo (1974) provided the first comparison study

of acupuncture and methadone. In a group of 70 male

addicts, half were administered AES to the lung point

and the remainder were treated with methadone. Fiftyone

percent of the AES group, compared to 28.6% of

the methadone group, remained abstinent for one year.

They speculated that effectiveness of AES would be

considerably higher with follow-up outpatient treatment.

Tennant (1977) observed that while all 18 patients in

an auricular staplepuncture group he treated reported

significant reduction of withdrawal scores on the first

day of treatment, only 3 of these patients returned for at

least 5 sessions; only 1 addict was successfully detoxified.

Many patients in the methadone comparison group

did complete their treatment and 13 were able to be

withdrawn from narcotics.

Man and Chuang (1980) concluded that acupuncture

was as effective as methadone for detoxification when 3 of

18 electroacupuncture compared to 3 of 17 methadone

clients were detoxified and remained in treatment.

In the Netherlands, Geerlings, Bos, Schakin and Wouters

(1985) compared electrostimulation to oral methadone

with a group of 93 heroin addicts admitted to an inpatient

drug detoxification unit. More drop-outs were found

among electrostimulation patients than methadone

detoxification patients. Logistic regression analysis found

that electrostimulation was more successful with older, 32 National Acupuncture Detoxification Association

severely addicted female heroin addicts.

A large scale comparison study with an 18-month

follow-up was reported by Newmeyer, et al (1984). This

outpatient study, conducted at the Haight-Ashbury Free

Medical Clinic in San Francisco, compared auricular

electroacupuncture detoxification to the combination

of auricular electroacupuncture plus medication and to

medication only. Of the 460 clients in the initial research

sample, only 72 chose auricular electroacupuncture

alone. In 30-minute sessions electrostimulation was

administered to the lung and shen-men ear points.

Clients who chose acupuncture were more likely to be

white, better educated and employed compared to the

general opiate treatment population of San Francisco

at the time. In comparison with methadone treatment

generally, auricular electroacupuncture clients were more

likely to drop out and on readmission were more likely to

choose methadone as opposed to choosing acupuncture

treatment again. However, auricular electroacupuncture

clients exhibited a dramatic improvement compared to

the methadone clients in symptomatology and mood

states, particularly anxiety and depression. They tended

to provide more negative urine tests and self reported

less heroin use than the medications group. Cost benefit

analysis found that acupuncture detoxification was

much less expensive than the medication and counseling

combination. The follow-up of successfully detoxified

subjects suggested that less severely addicted heroin addicts

were more amenable to the auricular electroacupuncture

treatment compared to longer term addicts. However,

findings at Lincoln Clinic suggest that severely addicted

users benefit most from manual auricular acupuncture

which helps to restore systemic balance (Smith, 1985).

Many confounding variables shade the outcome of the

Haight-Ashbury Clinic study, although it received much

attention at the time of its publication and has since been

cited as demonstrating that the outcome of acupuncture

treatment is questionable. Treatment consisted of

electroacupuncture using only two ear points which

produced an unexpectedly high level of pain for addicts.

The Lincoln Clinic five-point manual acupuncture

protocol now in use is relatively painless and has been

found much more effective than electroacupuncture

(Smith & Kahn, 1988). Acupuncture treatments at the

Haight-Ashbury Clinic were also less convenient than

medication treatments in terms of time and accessibility.

In addition, a peer support component was missing.

Clients were seen on an individual basis, missing the

group support that was available to those receiving

medication and counseling in the control section of the

study. Territorial disputes among the staff also contributed

to a non-supportive atmosphere. A class phenomenon

seemed to exist whereby "middle class whites" responded

to acupuncture on an intellectual level while "lower

class minority" clients were ostensibly alienated by the

approach. The appeal to diverse ethnic communities,

particularly to those who are economically disadvantaged

has since been substantiated, particularly for the Puerto

Rican, African-American, Native American, and Latino

communities (Chao, Smith & Davidson, 1990; Clark,

1990; Lane, 1989).

Promising results from a large comparison study have

also been reported from Dade County Florida (Konefal,

1990). In an unpublished report of the first phase of a

three year study in progress, auricular acupuncture was

found to be more beneficial than urine testing alone

in treatment of nonpregnant polydrug abusers in the

criminal justice system.

Placebo Control Studies

Was the success of acupuncture treatment due to a placebo

effect? Studies were needed to address this possibility. Leung

(1977) conducted an early placebo study and found that

narcotic addicts whose lung points were stimulated with

electroacupuncture exhibited fewer withdrawal symptoms

than subjects given placebo acupuncture. However, there

was such a high dropout rate for both groups that statistical

analysis was not possible.

A randomized single blind control study was conducted

by researchers at the University of Minnesota (Bullock,

Yumen, Culleton & Olander, 1987). This rigorous placebo

study used manual acupuncture detoxification treatment

on chronic recidivistic male alcoholics on an inpatient

treatment unit. Fifty-four severe alcoholics were randomly

assigned to one of two groups. Group 1 received manual

auricular acupuncture on points specific to the treatment

of addiction (shen-men, lung, kidney or liver) and two

wrist points (hoku and weiguan). Group 2 received sham

manual auricular acupuncture on points known to have

no relation to relief of withdrawal symptoms. Treatment

was divided into three phases: Phase I--daily treatment for

five days; Phase II--three treatments per week for 28 days;

Phase III --treatment twice per week for 45 days. Thirtyseven

percent of the treatment group (N=10) compared

to 7.4 % of the control group (N=2), completed all three

phases of the study. There were highly significant differences

between the two groups across all treatment phases on self

assessment of desire to drink, number of drinking episodes National Acupuncture Detoxification Association 33

and readmission for subsequent redetoxification. The

study also confirmed earlier observations that acupuncture

detoxification was cost effective: overhead costs were low,

minimal equipment was needed, and many patients were

treated simultaneously by one acupuncturist (Clark, 1990).

A second larger placebo study was conducted by Bullock,

Culleton and Olander (1989) and reported in The Lancet.

This study of 80 subjects employed a single blind random

assignment design to compare sham and real manual

auricular acupuncture in the treatment of recidivistic

chronic male alcoholic inpatients. The treatment for this

second trial was divided into slightly different phases:

Phase 1 — five times a week for two weeks; Phase 2 —

three times a week for four weeks; and Phase 3 — twice

a week for two weeks. The completion rate was higher

for this study than for the pilot: 21 (52.3%) of the 40

patients in the treatment group completed all phases of

the program compared to one (2.5%) of the 40 controls.

Only three (7.5%) treatment patients left the program

during Phase 1; 19 (47.5%) control patients terminated

treatment during the first phase. This was a very high

dropout rate among the control patients despite the

promise of incentive payments. At six month followup,

6 of the 21 patients in the treatment group who

had completed the program reported that they had not

taken any alcohol in the interim. In addition, none had

been readmitted to the detoxification center, whereas

39 control patients and all treatment patients who

had failed to complete the program reported drinking

episodes. Cost effectiveness was again found to be

significant. The encouraging results in program retention

with the acupuncture treatment group suggested a

valuable treatment tool had been found for this difficult

recidivistic population.

Another large control study of acupuncture treatment, this

time comparing acupuncture and methadone in relation

to heroin addiction, was reported August 15, 1990, from

the MIRA Outpatient Clinic at Bay View Hunter's Point,

San Francisco (Clark, 1990). This one and one half year

study, commissioned by the California State Legislature

has not yet been published but the results have been

reported to the State Legislature. Newmeyer participated

as one of the co-investigators on this study addressing

many of the issues raised by Newmeyer et al (1984).

The first phase of the study sought to assess the efficacy

of manual auricular acupuncture, using a randomized

single blind placebo design similar to the Bullock studies

(1987; 1989). During the 21 day detoxification trial,

100 subjects were followed for withdrawal signs and

symptoms, as well as attendance patterns and periodic

urine testing.

The treatment group, which received authentic auricular

acupuncture, attended the clinic more days and stayed

in treatment significantly longer than the control group,

which received sham auricular acupuncture. Sixteen

treatment as opposed to four control subjects remained

in the study beyond 21 days. However, fewer than 25%

of the treatment group remained in the study beyond

two weeks and only 33% of this group produced negative

urine tests at 15 days.

After this comparison was completed, another 50 addicts

were recruited and treated using true acupuncture points

for phase two of the study. This second phase compared

clients choosing acupuncture detoxification to clients

choosing methadone detoxification. Cross sectional

comparison was made of demographic characteristics and

treatment patterns of all detoxification clients choosing

acupuncture treatment compared to all detoxification

clients choosing methadone or other treatment modalities

throughout San Francisco during the time of the study.

Participants choosing acupuncture tended to be older. A

higher proportion was African American, as opposed to

the earlier findings of Newmeyer et al (1984).

The study's third phase investigated the treatment outcome

of acupuncture compared to methadone detoxification.

Thirty-three acupuncture and 30 methadone clients were

compared as to urine test results and self reports at the end

of 30 days. Nine of the acupuncture clients, or 27%, and

three of the methadone clients, or 10%, had negative urines.

Of the acupuncture clients with positive urine tests, 54%

were positive for heroin and 21% for cocaine. Similarly,

for the methadone clients who tested positive, 62% tested

positive for heroin although they were receiving methadone

maintenance and 21% tested positive for cocaine. Only one

subject, an acupuncture client, reported no use of drugs

or alcohol in the 30 day period prior to follow-up. It was

concluded that auricular acupuncture clients did at least as

well as methadone clients at follow-up. Acupuncture clients

were more likely to have negative urinalyses and report

longer periods of abstinence with fewer problem days than

their methadone controls. This was especially significant

because methadone treatment has several drawbacks not

found with acupuncture: methadone is an addictive drug,

has side effects, and is teratogenic (Cregler & Mark, 1986).

Clients reported the following responses to acupuncture

detoxification: they felt relaxed and comfortable during

the 20 to 40 minutes of the procedure, treatment

prevented withdrawal symptoms for about 8 hours with 34 National Acupuncture Detoxification Association

effects lasting increasingly longer as days in treatment

increased, and at one week they felt less irritable and

their thinking was more clear. Clients with many

previous detoxification experiences using other treatment

modalities appreciated the simplicity of the acupuncture

treatment. They felt they were not "just trading one

addiction for another" as was the case with methadone

maintenance (Washburn, Kennan & Nazareno, 1990).

Finally, clients reported that the group setting, where as

many as 40 people were seen at one time, was their one

consistently positive social interaction and found it a

pleasant way to begin the day.

Crack/cocaine users were the focus of a placebo control

experiment designed by Lipton et al (1990) following

the protocol established by Bullock et al (1989). One

hundred fifty subjects were randomly assigned to receive

experimental acupuncture or placebo acupuncture only

in an outpatient setting for one month. Although it

usually recommended that acupuncture treatment be

administered in conjunction with counseling and other

recovery services, for the purposes of research clarity these

subjects received acupuncture only. Outcome measures

included urinalysis profiles, self reports including the

Addiction Severity Index (McLellan, Luborsky, O'Brien

& Woody, 1980) and treatment retention. Urinalysis

results indicated that after two weeks of treatment

experimental subjects had significantly lower cocaine

metabolite levels than the placebo controls subjects.

The researchers noted that "no specific pharmacologic

treatment for cocaine abuse is currently widely used or

generally recognized as effective" (p. 27). They further

observed that acupuncture seems to be the most widely

used medical treatment for crack/cocaine abuse in New

York City. Lincoln Clinic alone has treated more than

8,000 such patients.

Studies Regarding Pregnant Addicts

Although no research has been published as yet specifically

addressing auricular acupuncture detoxification of

pregnant women, one recent pilot program demonstrated

the success of acupuncture treatment with substance

abusing pregnant women. Fifteen cocaine addicted

women receiving treatment during pregnancy at a high

risk prenatal clinic at Columbia Presbyterian Hospital in

New York City were treated with acupuncture for chemical

dependency. They all received at least five prenatal care

visits as well as supportive counseling. When the birth

weights of infants born to these women were compared

to birth weights of fifteen infants born to women who

received comparable care without the acupuncture

treatment, the birth weights in the treatment group

were found to be significantly higher than those who

did not receive acupuncture, 3400 grams compared to

2800 grams. The women who did not originally receive

acupuncture due to its unavailability at their particular

clinic in the multilevel structure of clinics at this hospital

chose to receive acupuncture after delivery (M. Smith,

M.D. personal communication, October 23, 1992).

Another study of pregnant substance abusers receiving

acupuncture treatment is currently underway at Saint

Raphael's Hospital in New Haven, CT. More than

300 women have been treated, with only 50 having

positive drug toxicologies at delivery. There have been no

untoward effects from the acupuncture, no deaths, and

no Intensive Care Unit [ICU] admissions (W. Rugero,

personal communication, February 11, 1992).

In 1989 an outcome study on postpartum women was

reported (Chao et aI, 1989). The treatment of 290

postpartum substance abusing women whose babies had

been held in the hospital because of positive cocaine

toxicologies at delivery yielded positive results. Seventy

percent of all postpartum referrals attended acupuncture

treatment and counseling on the prescribed schedule

for at least two consecutive weeks. Fifty percent of all

referrals provided an average of 10 or more negative daily

urine tests. It was on this basis that more than half of

the infants retained at the hospital after delivery due to

the addiction of the mother — boarder-babies — were

returned to the custody of their mothers. Women who

were referred immediately postpartum had significantly

fewer positive urine tests than women referred two

months or more after delivery. The latter group had only

a 37% return of infants as opposed to 58% in the entire

sample. The savings in foster care expenses alone make

this a compelling treatment consideration.

Two innovative perinatal substance abuse treatment

programs incorporating acupuncture as a primary

treatment component have been recognized for their

clinical success.

The first, the Maternal Substance Abuse Acupuncture

Services of Lincoln Hospital, an outpatient clinic

established in 1986, treats primarily crack/cocaine

dependant women. They have developed a six-week

program and a six month protocol for the 80% of

their clients who are referred by the Child Welfare

Administration. According to director Nancy Small,

the program recognizes that "women are busy people"

(Ackerman, 1992), the program is organized so that National Acupuncture Detoxification Association 35

clients need be in the clinic no longer than two hours

per day. In depth counseling is provided after 10 days

of negative urine toxicologies. Counseling, 12-Step

meetings, "Women's Rap Group" group education/

discussion sessions and parenting classes are all

mandatory treatment components. The success rate with

court referred clients, defined as drug free for at least two

months is greater than 50% (AHA, 1991).

The second program, the Ramsey County Maternal/

Child Project, is located in St. Paul, MN. This unique

program provides acupuncture treatment for its clients in

their own home as well as in a group/clinic setting. Based

on a family preservation model, treatment is provided

for twelve weeks or more in the home by a team which

includes the acupuncturist, child protection specialist,

family therapist, chemical dependency counselor and

a public health nurse. In this way all the members of

the woman's immediate support environment can be

addressed. The prevention impact of these services has

been widely recognized and results in a reduction in

emergency use of medical and social services lot only

for the identified client but also for the extended family.

A program modeled on this protocol has recently been

licensed as an institutional care provider, although all

services are all home-based, and is contracting with

private insurance companies as well as public social

service agencies (K. Ganley, personal communication,

October 3, 1992).

The literature regarding acupuncture detoxification has

revealed many anecdotal clinical reports, comparison

studies, and four recent placebo control studies. In the

early studies, two auricular acupuncture points (lung

and shen-men) were treated by electrostimulation.

Electroacupuncture was found to be only moderately

satisfactory. It was also expensive, since electroacupuncture

involved costly equipment and was usually administered

on an inpatient basis. In more recent studies, manual

stimulation of three to five points (shen-men,

sympathetic, kidney, liver and lung ) has been used

with greater clinical and cost effectiveness. Reports on

perinatal application of acupuncture treatment were also

described, including two scientific control studies not

yet published. Documentation of this ground swell/grass

roots treatment phenomenon is clearly progressing.


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The use of auricular acupuncture in treating acute drug

withdrawal began in Hong Kong in 1972. Its practical

application in the traditional drug treatment setting evolved

at New York City’s Lincoln Hospital during the 1970s,

and over 250 acupuncture programs in diverse treatment

settings have since been established world wide, based on

the Lincoln protocol. Acupuncture treatment offers the

client support during acute and postacute withdrawal

through relief of classic symptoms. It has also been found

useful as an entry point to treatment and/or recovery in

such nontreatment settings as jails and shelters, and has

particular efficacy in the treatment of resistant clients, and of

prepartum and postpartum women. Though acceptance of

the legitimacy of acupuncture by the chemical dependency

community has been guarded, both research and outcome

studies indicate that it holds promise as a complement to

traditional substance abuse modalities.

The medical historian Manfred Porkert has called

Chinese medicine “an intellectual treasure trove”

(Porkert & Ullman, 1988; p. 268). Indeed, apart from

whatever specific clinical efficacy it may have, which is

still not well understood in the west. A study of Chinese

medicine in general, and its most publicized component,

acupuncture, can be most instructive in the nature of

life, disease, and recovery. This ancient wisdom is now

coming to shed much needed light on the field of drug

and alcohol treatment.

Acupuncture has, according to Porkert and Ullman (1988,

p. 37), “stubbornly and successfully resisted assimilation”

into Western medical science. This is perhaps less the case in

Europe. In fact, auricular (ear) acupuncture, which is used

in the chemical dependency treatment setting, is in part a

European as well as a Chinese development. Acupuncture

as it came to be used in Europe is itself a hybrid of Chinese

acupuncture, which is only a small part of traditional

Chinese medicine, whose primary emphasis is on herbs.

Acupuncture protocols were passed along in Europe

beginning in the early 17th century in pamphlets that were

filled with contradictory information concerning point

location and diagnoses. Curiously, during the post World

War I period, when the popularity of acupuncture was

spreading in Europe and gaining the attention of European

medical societies, Western medicine itself was replacing

Oriental medicine in China. During this Westernizing

“open door” Nationalist Period in China, under Chiang

Kai-shek and the influence of the Rockefellers, acupuncture

and other ancient Chinese medical traditions came under

attack as primitive and their practice became temporarily

outlawed. Clinical knowledge went “underground” until,

with Mao Tse-tung’s Cultural Revolution of the 1940s and

‘50s, there was a revision and a revitalization of traditional

Chinese Medicine.

These revised texts poured into Europe and gained a

degree of popularity in France, where, in 1955, Dr. Paul

Nogier (1983), using an instrument to measure the level

of electrical activity on the surface of the skin, discovered

that all of the traditional Chinese acupuncture meridians

or arterial pathways were accessible at points of the ear.

Clinical experimentation and research in China soon

confirmed this, and both Chinese and “Nogier” ear

charts began to appear and find clinical application. This

was fortuitous for treatment in a public setting, since a

large group of individuals can be treated simultaneously

without the need for private treatment rooms, which are

required for the full body treatment normally associated

with acupuncture.

It is of some historical irony that this very specialized

hybrid form of acupuncture as it has evolved in the drug

and alcohol treatment setting in the United States is now

being “exported” to Japan and Hong Kong to address the

growing drug problem in that part of the world where

acupuncture originated over 2,500 years ago.

In 1991, interest in acupuncture in general in the United

States was piqued by an article written by the syndicated

American newspaper columnist James Reston. He had

visited China and been stricken with acute appendicitis.

He underwent surgery there, and acupuncture was used

as an anesthetic. His experience with this very specialized

application of acupuncture, and that of physicians and

others who visited China with President Richard Nixon in

1972, resulted in a sprinkling of Western research involving

pain (Man, 1972; Melzack, 1973, 1974; Wall, 1978) and

in the eventual discovery that acupuncture prompts the

production of beta-endorphins, the body’s “endogenous

opiates,” in animals. The transmitter or “information”

substances for which research data has established a

connection with acupuncture include alpha- and betaendorphins,

leu- and met-enkephalins, dynorphin A and

B, substance P, serotonin, epinephrine, noradrenalin,

dopamine, acetylcholine, adrenocorticotrophic hormone

(ACTH), glycine, glutamic acid, the prostaglandins, and

cyclic AMP and GMP (Bensoussan, 1990, pp. 101-126).

Despite the fairly extensive research in this area, precisely

how acupuncture works remains a mystery, at least to the

Western scientific mind. Most simply, it can be said that

acupuncture moves energy. In the Chinese view of the National Acupuncture Detoxification Association 43

body, life energy, or chi, circulates through pathways that

are called, in the West, “meridians.” “Disease” is seen as

a stagnation, blockage, or deficiency of this energy. The

acupuncturist places needles which, based upon diagnosis,

will stimulate an opening of and, therefore, a movement

of energy through the appropriate pathways. The effect

is homeostatic. For example, a person with an excess of

stomach acid who is needled at a point called “Stomach

36” will experience a decrease in the amount of acid in the

stomach; a person with a stomach acid deficiency, needled

at the same point, will experience an increase in stomach

acid (Sodipo & Falaiye, 1979). Again, the mechanism of

action involved in this phenomenon is not known.

Acupuncture is not a panacea, and it loses much of its

efficacy in the treatment of chemical dependency when

practiced in isolation from the more traditional Western

modalities of counseling, pharmaceutical therapies, 12-

step programs, and urine testing. It is best seen as an

adjunct or a complement to these other forms, and, in

this regard, it is an exceedingly fluid modality. We are

beginning to see that, properly used, it can enhance and

support the program goals of virtually any traditional

chemical dependency treatment setting.

When used in an inpatient detoxification setting, alcoholic

seizures virtually disappear, even without the use of

pharmaceutical intervention. One of the first residential

detox programs to implement acupuncture was Portland,

Oregon’s, Hooper Memorial Detox Center in 1987.

Clients entering this 5-day residential detox-to-referral

program were 6 times less likely to return in the following

6 months than clients who entered the facility prior to

the implementation of twice-daily acupuncture, and the

program’s overall completion rate increased from 60% to

92% (Lane, 1988). A residential, social model, detox-toreferral

program operated by Santa Barbara, California’s,

Council on Alcoholism and Drug Abuse opened in

June of 1991, offering twice-daily acupuncture. Only 2

alcoholic seizures were reported out of the first 150 clients,

the majority of whom were late stage, chronic alcoholics,

and completion rates for the program are comparable

to Hooper’s (Brumbaugh, 1992). In the treatment of

acute heroin withdrawal, acupuncture is also effective,

the symptoms of “kicking” often resembling a mild flu.

And the cravings, anxiety, and depression of crack cocaine

withdrawal become manageable.

Subjectively, acupuncture treatment offers to the client

support during acute withdrawal through relief of classic

withdrawal symptoms. According to Michael Smith,

M.D. (1979), the body’s response to acute withdrawal

from toxic drugs is a “crisis in elimination,” which is

seen as a “healing crisis.” He suggests (Smith & Kahn,

1988) that “acupuncture works by releasing blockages

of energy and correcting imbalances of energy flow,”

and that its physiologic effects also likely involve

homeostatic action on the autonomic nervous system,

various neurotransmitters, and elements in the pituitary

subcortical axis.

In an outpatient, residential, or day treatment setting,

counseling sessions are greatly enhanced by the relaxed and

nonhostile ambience created by the acupuncture treatments,

and it provides a useful tool in dealing with the otherwise

virtually nontreatable symptoms of “protracted abstinence

syndrome” or “postacute” withdrawal. Used in conjunction

with daily urine testing in the outpatient setting, it provides

a higher ground for the counselor in dealing with the

perplexing issues of relapse and relapse prevention.

Acupuncture is also well suited as an entry point to

treatment and/or recovery in such diverse nontreatment

settings as jails, public defender’s offices, homeless

and battered women’s shelters, and neighborhood

community centers and medical clinics. In this latter

arena, it is providing not only an entry point into

treatment/recovery for the chemically dependent client,

but also a long awaited entry point into general medicine

for acupuncture itself. For example, a program of the

Multicultural Inquiry and Research on AIDS (MIRA)

Clinic located in Bayview-Hunter’s Point, San Francisco,

under the auspices of the University of California San

Francisco Center for AIDS Prevention and San Francisco

General Hospital, was started to study the effects of

acupuncture on the detoxification of heroin addicts, and

has subsequently expanded to include general medicine.

Acupuncture is also now in use in general medical

treatment at Lincoln Hospital in The Bronx, New York,

where it began as a treatment for acute drug withdrawal.

It is important to note in this regard that acupuncture

offers the unique feature of more expansive protocols to

address physical and psychological conditions that may

have been precipitative factors in the chemical dependency,

such as chronic pain or depression, conditions which

may have discouraged clients in chemical dependency

recovery. With acupuncture, integrated and drug-free

treatment options are immediately available for such

“relapse trigger” pathologies that may become unmasked

as chemical abstinence is achieved. This can be especially

helpful in the treatment of dual diagnosis clients, since

Chinese Medicine has been shown to be effective in

the treatment of depression, chronic anxiety, mania, 44 National Acupuncture Detoxification Association

insomnia, schizophrenia, and other mental disorders

(Bensoussan, 1990, pp. 39-41, 109).

The use of auricular acupuncture in treating acute drug

withdrawal began in Hong Kong in 1972. It was used

sporadically throughout the United States during the

1970s, and some experimentation with the method was

done at the Haight Ashbury Free Clinic in San Francisco

(Seymour & Smith, 1987). But it has been at Lincoln

Hospital in New York, under the guidance of Michael

O. Smith, M.D., Director of the Hospital’s Division of

Substance Abuse, that the protocol has been refined and

expanded, and has taken its firmer root.

Lincoln is located in the South Bronx where alcoholism

and drug addiction have been endemic for many years.

Smith’s clinic was primarily a methadone program in

1973 when he first read of Dr. H.L. Wen’s research in

Hong Kong (Wen & Cheung, 1973) concerning the

treatment of heroin withdrawal with acupuncture. Dr.

Wen, a neurosurgeon, had made his initial discovery while

administering acupuncture anesthesia to a patient who

happened to be in heroin withdrawal. The withdrawal

symptoms disappeared, and Wen subsequently conducted

a formalized study. By 1980, Wen had replicated the

positive outcomes of his research and published no fewer

than 10 additional studies (Bensoussan, 1990, pp. 101-

126) concerning narcotic withdrawal symptoms and

acupuncture, including research on the adjunctive use of

the opiate block naloxone to essentially flush opiates from

receptor sites in the brain to speed up the detoxification

process. It was discovered that naloxone also partially

blocked the effects of acupuncture itself. This led to

additional research on the relationship of acupuncture to

the production of endogenous opiates.

Smith, interested in potential alternatives to methadone

treatment, began employing Chinese doctors at Lincoln

to experiment with different protocols in the treatment of

heroin addiction. Wen’s research had involved electrical

stimulation as well, and Lincoln Hospital experimented

extensively with electrostimulation protocols, eventually

discontinuing its use when it was discovered that

manual acupuncture resulted in more consistent clinical

outcomes. A 5-point auricular protocol was eventually

established, consisting of 4 to 5 points in each ear,

including kidney, liver, lung (or heart), sympathetic, and

shenmen. By 1975, acupuncture had become a permanent

feature of the Lincoln program, not only for heroin

dependence, but for alcoholic patients as well. And,

in 1985, when the “crack” cocaine epidemic reached

New York, it was discovered that the same protocol was

effective in addressing the cravings, anxiety, and dysphoria

accompanying “crack” withdrawal (Lipton, Brewington,

& Smith, 1990; Smith, 1988).

In 1985, Smith founded the National Acupuncture

Detoxification Association (NADA, 3115 Broadway,

#51, New York NY 10027), an organization representative

of experts in chemical dependency as well as Oriental

Medicine. NADA’s function is to provide training and

consultation to treatment programs that have begun

throughout the world and to assure specific clinical and

ethical standards in the certification of “acupuncture

detox specialists.”

Though much of NADA’s focus as well as the research has

been upon the acute detoxification phase of withdrawal,

clinical experience since NADA was established has

shown that acupuncture has applications as well for

postacute or “latent” withdrawal. Clients return to the

acupuncture clinic months and even years into recovery

for “tune-ups.” Many clients find the far more expansive

application of traditional Chinese medicine to be a

valuable tool in treating the anxiety-depression-craving

phenomenon that Edward Brecher (1972) termed the

“post-addiction syndrome.” These symptoms, as well as

the majority of Terence Gorski’s symptoms that forebode

alcoholic relapse (1987) correspond with “disorders of

the spirit” in the classic Chinese medical texts and are

very responsive to traditional Chinese medical treatment,

which includes herbs as well as acupuncture (Kaptchuk,

1983, pp. 45-46).

Oriental medical schools, however, in which

acupuncturists receive their education and training, are

generally as deficient in chemical dependency curricula

as are their Western counterparts. Therefore, a primary

role of NADA is to provide acupuncturists with basic

education in chemical dependency and recovery through

intensive 3-day NADA certification training coupled with

a clinical internship. Chemical dependency professionals

working in the acupuncture program also benefit from this

training, since clinical success requires a complementary

relationship between the counseling and acupuncture

aspects of the treatment program. In regions of the

country where the number of licensed acupuncturists has

been insufficient to meet the demand for service levels,

state laws governing the practice of acupuncture have

been modified to allow for “acupuncture detoxification

specialists” generally chemical dependency counselors

or nurses who are specially trained to perform auricular

treatment only when working under the supervision of

a licensed or certified acupuncturist. This has created National Acupuncture Detoxification Association 45

a new level of professional supervisory positions for

acupuncturists as well as a potential entry point into

the acupuncture profession for people working in the

recovery field.

The NADA protocol has a precise focus, elegant in its

simplicity. In its original application in the outpatient,

drop-in setting, the clinic is to be, like the 12-step

program, “barrier-free” in that there are no motivational

or other screening requirements for entering or continuing

acupuncture treatment. Clients are instructed to come as

“clean and sober as they can” for treatment, and treatment

is recommended daily, in the same “one day at a time”

rhythm as recovery, so that the treatment, as Michael

Smith has said, “will be as reliable as the drug was.” While

12-step meetings are frequently held in proximity to

the clinic, and while group and individual counseling is

generally available on site, participation in these activities

is not a condition of receiving acupuncture treatment.

The clinic protocol is to be “empowering, “ in that clients

do everything they can for themselves, such as “prepping”

their own ears with an alcohol solution and cotton. In

some NADA clinics, clients select their own personal

autoclaved or pre-packaged disposable needles. Often,

clients even use a mirror to remove their own needles

upon leaving. The acupuncture staff are counseled not to

“fuss” with clients, question them as to relapse, or lecture

or confront them in any way. Clinic rules are minimal,

and clients are barred from treatment only for disruptive

behavior. Such instances are rare in this setting.

The NADA protocol includes “sleep mix” tea, a recipe also

developed at Lincoln (Smith, 1979), using the Western

herbs chamomile, hops, catnip (sometimes substituted

with valerian root), scullcap, peppermint, and yarrow.

Clients drink it during or following treatment and are

encouraged to take it home to help them sleep.

Clients are treated for 45 minutes in a group setting,

seated. Talking — especially drug-talk and “war stories”

— is discouraged. In observing this process, where there

are no behavioral or cognitive expectations placed on the

clients, where clients are “free to do nothing,” one gets a

sense of some of the more discreet resonances between

this modality and the form and structure of the 12-step

meeting. There is an implicit trust established in the

client’s ability to find his own way in recovery, and the

responsibility of the clinic is to make available the most

helpful tools for the task.

This clinical ambience is often unsettling at first for new

clients, especially the more “treatment-seasoned” ones.

They may spend the first few days of treatment waiting

for “the program” to begin. They will perhaps “test” the

program by “chipping” or coming under the influence,

and find that they are welcomed back just the same.

While traditional alcohol and other drug treatment

strategies require an external focus, here, in the NADA

clinic, the attention of the client is invited inward, where

the ultimate responsibility for recovery lies.

According to John D. McPeake, B.P. Kennedy, and S.M.

Gordon (1991), a shortcoming of traditional alcohol and

drug treatment is that it ignores a primary motivation

for drug use, which is mood modification. One aspect

of the efficacy of acupuncture may be that, to degrees

that vary with individual clients, the treatment elicits

an experience of altered consciousness. Heroin addicts

often self-report euphoria as an altered mood response to

acupuncture, induction of which has shown a tendency

to reduce baseline withdrawal and craving (Childress,

McLellan, Natale, & O’Brien, 1986).

An additional subjective effect of the treatment is a

feeling of relaxation and stress-reduction. For this reason,

it is not unusual in acupuncture clinics to see counselors

or other staff receiving treatment with the clients.

NADA held its first annual convention in February,

1991, in Santa Barbara, California. The roster was

dominated not by chemical dependency professionals

nor by acupuncturists but by representatives of the

criminal justice community, including Superior Court

Judge Herbert Kelin, former “Drug Czar” of Dade

County, Florida; Mark Cunniff, Executive Director of

the National Association of Criminal Justice Planners in

Washington, D.C.; and Orville Pung, Commissioner of

Corrections, and James Bruton, Director of Adult Release,

of the Minnesota State Department of Corrections.

Local presenters included the Santa Barbara Chief of

Police, and the Director of Administrative Services for

the Santa Barbara County Department of Probation.

They came, as advertised in the conference brochure, to

herald the arrival of a “new beacon on the dark landscape

of chemical dependency treatment.”

That the strongest advocates for acupuncture treatment

for chemical dependency are members of the criminal

justice community is echoed by the fact that much of

the funding for acupuncture-based chemical dependency

programs in the United States comes not through

traditional drug and alcohol sources but through criminal

justice sources. There are clinical reasons for this, and they

reveal a great deal about the efficacy of acupuncture, and

have resulted in a growing bias among practitioners in

this field that the premier “window of opportunity” for 46 National Acupuncture Detoxification Association

intervention in drug treatment lies on the continuum of

arrest, judication, incarceration, and probation or parole

of the drug offender.

The standard scepticism about drug and alcohol

treatment in general in the law and justice community

derives from the fact that law enforcement and treatment

have traditionally labored under conflicting definitions

of alcoholism and drug addiction. The clinical (and

recovering) community has long accepted the disease

of alcoholism/addiction as a chronic relapsing disorder

in which recovery is typically achieved only through a

process of “slips and starts.” For this reason, there has been

a shift in chemical dependency treatment away from the

concept of detoxification and toward relapse prevention

or “sobriety maintenance.” Clinical experience is clear

that rare is the addict or alcoholic who negotiates the

transition from use to non-use in a single movement.

While individual judges, probation, or parole officers

may indeed be personally aware of this relapsing nature

of typical early recovery, the criminal justice system itself

has not been able to tolerate relapse since its charge

is not to bring about recovery per se, but to prevent

the resumption of the criminal behavior that relapse

precipitates. This “hard line” either/or definition of

recovery as requiring total and continuing abstinence

has been justified, for in traditional drug and alcohol

treatment, relapse is generally catastrophic, resulting in

treatment drop-out. This is true of course in residential

intensive or social model treatment, often the “treatment

of choice” for the most chronic addicts and alcoholics,

because a “clean and sober” living environment is

tantamount to the program’s success. But it is also true

of outpatient treatment modalities because of the special

difficulties of the chemical dependency counselor in

dealing with the problems of relapse.

In the highly successful acupuncture-based drug

diversion programs, however, in such varied locations

as New York City; Miami; Portland, Oregon; and Santa

Barbara and Santa Maria, California; a higher ground

can be taken by the judge or probation or parole officer,

because the acupuncture-based program is able to keep

the client in treatment during the early relapsing period.

Relapses here tend to be shallow and noncatastrophic.

Clients “keep coming back,” and, over time, abstinence

is achieved. Dade County Judge Stanley Goldstein, who

presides in Miami over a “drug court” that hears only first

and second cocaine offenses, began diverting offenders

to a 3-phase treatment program in October 1989. The

first phase of the program involves daily acupuncture

and urine testing. Defendants return to court during

this phase, and Judge Goldstein reviews their urinalysis

records. His response to intermittent positive tests is

not punitive; rather, he encourages defendants in their

struggle and commends them for the “clean” days they

have achieved. This unusual posture of relapse tolerance

is well justified, for of the first 1,200 defendants to

complete the first phase of the program, only 7 were

rearrested during the first 6 months (Konefal, 1990),

compared with an average 2-week re-arrest time for this

population prior to implementation of the program.

The concept of daily urine testing as it is used in

Miami was also a development of the Lincoln Hospital

program. The notion of urine testing in a therapeutic

setting may seem at first an anathema, since urine

testing is traditionally punitive, a clear manifestation of

judgmentalism, giving the treatment program the role

of critic rather than supporter of the client’s recovery

process. In practice, however, quite the opposite turns

out to be the case. The goal is not punitive disclosure

but education and therapeutic feedback. Unlike urine

testing in a law enforcement setting, clients assume much

of the responsibility for self-monitoring the urinalysis

process. Fears that clients will provide fraudulent test

results under these conditions have not been justified. As

Michael Smith has aptly said, “drug addicts lie, but they

don’t lie every day.” Once the daily treatment rhythm has

been established, and once the client has learned that a

positive urine test will not result in program expulsion,

attempts to deliver “false negatives” are uncommon.

To fully understand the utility of such testing, a brief

examination of the dynamics of relapse may be helpful.

In the traditional relationship between a chemical

dependency counselor and client, there is an implicit

trap surrounding the issue of relapse. In the Rogerian and

other generally accepted models of chemical dependency

counseling, the appropriate posture of the counselor is

one of nonjudgmental acceptance. The overt agenda is to

validate the experience and feelings of the client. Trust is,

of course, a necessary prerequisite for this stance. Honesty,

particularly self-honesty, is the hallmark of recovery. The

counselor wants the client to be honest about his or her

feelings and behavior. And, if the counselor is skilled,

the trust and honesty will come early in the relationship,

because the client desires it as well. It will become part

of what is called in recovery the “honeymoon” period -

generally the first 30 days.

The difficulty, of course, is that both counselor and client

know that addiction is a disease characterized by relapse. National Acupuncture Detoxification Association 47

The counselor cannot, in good conscience, validate relapse

when it happens because the overriding covert agenda in

the relationship is for the client to stop relapsing. This

agenda implies, of course, judgement, which is contrary

to the goal of therapy.

This is a bind, and one to which the client is not

insensitive. If the counselor has done a particularly good

job and has won the trust of the client, then, when the

generally inevitable relapse occurs, the client’s usual move

will be to drop out of treatment so as to “protect the

counselor from disappointment.”

Daily urine testing in a therapeutic acupuncture-based

setting discharges this dilemma. At Lincoln, and in

other similar programs, the computer software interfaces

with an on-site urine testing machine. With substantial

client numbers, the cost of urinalysis for the single drug

for which the client has been referred to treatment can

be reduced to as little as a dollar and a half per test.

Multiple client urines are tested at once, and the data is

downloaded to the client’s attendance file. A print-out

of urine toxicity patterns over the period of the client’s

treatment attendance can be generated while the client

is having acupuncture. A subsequent counseling session

that begins with the client having this print-out in hand

can commence at an entirely different therapeutic level,

free from the potentially codependent “how are you

doing?”, because “how the client is doing” is already

objectively established. The content of the answer to the

question, “how are you doing?” is not being elicited by

the counselor. Nor does the answer depend upon the

client’s best recollection of when he or she last used, but

rather has been provided by the client’s own body, so one

important element of denial is also dispelled. Clinical

experience shows that clients come to enjoy this daily

feedback. It can perhaps be likened to a person who is

trying to lose weight stepping on the scale each morning.

A significant barrier to treatment in criminal justice

settings is that acupuncture is designated by Federal law as

an “experimental procedure,” thus precluding mandated

application among incarcerated, probated, and paroled

populations. Its current use is therefore limited to those

who “volunteer” for treatment. Even so, the use of the

auricular acupuncture protocol in incarcerated settings

illustrates its application beyond the detoxification phase

and its potential for addressing some of the social and

economic problems attending chemical dependency.

In Minnesota, it has been integrated into 4 state prison

treatment programs, one of which is a research program.

Elsewhere, the protocol has been to treat inmates with a

history of chemical dependency daily for 30 days prior

to their release. In the Dade County Stockade in Miami,

from late 1989 to the present, the number of inmates

treated in this manner has grown from 140 to 527. An

independent research project to study the impact of this

treatment on re-arrest has just begun as of this writing.

Similar programs have begun in Santa Clara, San Luis

Obispo, and Santa Barbara Counties in California. A

preliminary study of Santa Barbara County Jail inmates

indicates that those receiving 24 or more treatments during

the last 30 days of their incarceration are two-thirds less

likely to be re-arrested in the 2 months following release

than those receiving 6 or fewer treatments (Brumbaugh

& Wheeler, 1991). In that an acupuncturist can treat as

many as 35 inmates in an hour, this treatment modality

shows great promise as a cost-effective method of inmate

reduction in our vastly overcrowded jails.

Also promising is the use of acupuncture in homeless

shelters, where alcohol and drug treatment is often resisted

due to the unmanageability of withdrawal symptoms in

such a setting, and where shelter client safety has become

an increasing concern. A Santa Barbara program operates

an acute detoxification program with clients who are

under the custodial care of a homeless shelter at night.

Clients receive two acupuncture treatments daily, and

the program has had a minimum of withdrawal-related

medical emergencies, seizures, or social altercations.

Shelter staff report that the program has had a positive

effect on management of the facility in general. The

program has a 90% program completion and aftercare

program placement rate (Brumbaugh, 1992).

Acupuncture treatment has also found successful

application in the treatment of chemically dependent

prepartum and postpartum women (Ackerman, 1991),

and a variation of the protocol is being used to treat

chemically exposed infants (Keenan, 1991). Clinics that

use acupuncture as part of the treatment design and

that are specifically focused on the needs of pregnant

women are now in operation at Lincoln Hospital (Smith,

1990), at the MIRA Clinic at Bayview-Hunter’s Point

in San Francisco, in Miami at the Metro/Dade Office of

Rehabilitation Services, and in St. Paul, Minnesota, at

the Maternal Child Project.

Acupuncture is of particular efficacy with prenatal

women, because, while it is well known that the common

substances of abuse such as alcohol, cocaine, heroin,

amphetamines, PCP, and marijuana have documented

teratogenic potential for the fetus (NAPARE, 1989),

medications used to accomplish detoxification are also 48 National Acupuncture Detoxification Association

teratogenic (Cregler & Mark, 1986). There is concern

that abrupt withdrawal during pregnancy may be

damaging to the mother and fetus. Acupuncture reduces

this risk by supporting the process of withdrawal and

avoiding the impact of sudden abstinence.

The enthusiastic law enforcement speakers at the 1991

NADA conference were, unfortunately, “preaching to the

converted,” for the small audience was comprised largely of

people already working in this frontier field. Although there

are now over 175 acupuncture-based chemical dependency

programs operating in the United States, and dozens

more elsewhere in the world, acceptance of acupuncture

as a legitimate treatment component by the chemical

dependency community has been, at best, guarded. In the

areas of the country where acupuncture has flourished, it is

highly localized. While it has a firm foothold, for example,

in the chemical dependency treatment delivery systems in

the cities and regions mentioned above, it has failed to gain

acceptance with the departments of drugs and alcohol in any

of the states where these programs exist. The single exception

as of this writing is New York, where the State’s Division

of Substance Abuse Services recently released a concept

paper (Puccio, 1991) strongly advocating acupuncture as a

“threshold technology,” most effective in “assisting cocaine

and/or alcohol addicted clients who resist initial treatment.”

Acupuncture, according to the paper, “works in concert with

traditional drug abuse treatment approaches (and) transcends

the barriers to all treatment components.”

Acceptance at the Federal level is also reserved. A February

1991 memo from the National Institute on Drug Abuse

(NIDA) to the U.S. Congress Select Committee on

Narcotics Abuse, states that they feel this treatment

modality “shows some promise,” but that more research

is required (Egertson, 1991). The only acupuncture

research they are currently funding is a new cocaine

treatment research project in Minneapolis and a 3-year

study in Miami focussed on IV needle use. At less than

$1,000,000 each, these are among the smallest of NIDA’s

current research grants. Miami is a 3-phase grant. The first

phase has been completed, and the experimental group

receiving acupuncture has demonstrated a faster rate of

delivering clean urines than groups receiving counseling

only. Also of interest is that, with acupuncture, court

referred clients responded more favorably than selfreferred

clients (Grossman, National Institute on Drug

Abuse, personal interview, July 1992).

The Federal Office of Treatment Improvement (OTI), in

their first funding cycle in 1990, received one application

that included acupuncture. They denied the application

by a 5-to-4 vote, questioning “the efficacy of the use

of acupuncture in (the treatment of high risk narcotics

addict probationers)” (OTI, 1990). Due in part to the

lobbying efforts of the National Association of Criminal

Justice Planners, OTI’s director Beny Primm has since

been quoted as stating that future funding applications

to OTI will not be denied “solely on the basis that they

contain acupuncture components” (Cunniff, Executive

Director, The National Association of Criminal Justice

Planners, 1331 H Street N.W., Suite 401, Washington,

DC 20005; 1991). Charles Rangel (1990), Chairman of

the Select Committee on Narcotics Abuse and Control,

in a letter to Beny Primm in July of 1990, perhaps also

contributed to the softening of OTI’s position by stating

that “acupuncture (though) not, as yet, fully understood

... should not be overlooked or rejected offhand.” Citing

the dramatic success of the cocaine diversion program in

Miami, Rangel went on to say that “This is precisely the

kind of innovative experiment that Congress has provided

for through demonstration grant funds. I strongly urge

you to look into this program, to consider it objectively,

with an open mind and without prejudgment.”

But again, such support is isolated. In the voluminous

triennial report of the Department of Health and

Human Resources (DHHS, 1991) to Congress, in their

cataloging of innovative new drug treatment modalities,

mention is made of such experimental treatment tools as

pocket computers· by which nicotine addicts can keep

track of the number of cigarettes smoked during the day,

but there is no mention of acupuncture in the document.

This resistance, often tacit, like the Western cultural

resistance to acupuncture in general, is understandable.

Acupuncture, and the “invisible circulatory energy”

paradigm of the organism upon which it is based, is

implicitly nonrational. In that its basic premises about

the body are based upon energic rather than somatic

considerations (Porkert & Ullman, 1988, pp. 13-63, 265-

278), it is in fundamental conflict with Western medical and

scientific philosophy, from which current drug treatment

strategies and theories have developed. Like Alcoholics

Anonymous, itself a historical and cultural reaction against

Western “scientism” (Kurtz, 1979, p. 171), acupuncture

addresses addictive disorder on a “nonrationalistic” and

subjective plane where the issues of recovery lie not in

the relationship of the addict with the external world or

“fix,” but rather in relationship with self, in the possibility

of healing from within. Oriental medicine characterizes

addiction in terms such as “yin deficiency,” “stuck liver

chi,” and “empty fire syndrome.” Such unfamiliar and National Acupuncture Detoxification Association 49

“nonmedical” tautology is not easily embraced by the

“rational” Western drug treatment establishment.

However, in addition to the studies already cited, some

research under the parameters of Western scientific

investigation has been achieved. In 1987 in a medically

supervised study of chronic homeless alcoholic men in

Hennepin County, Minnesota, 80 subjects were divided

into 2 groups matched for drinking history and prior

treatment experience. The control group were given

sham acupuncture, needled at nontherapeutic points a

few millimeters away from standard treatment points;

53% of the treatment group completed the 8-week

treatment regimen, compared with 2.5% of the control

group. During the 6-month follow-up of the 2 groups,

the control group had more than twice as many drinking

episodes and had to be re-admitted to detox more than

twice as often as the experimental group (Bullock,

Culliton, & Olander, 1989). These same researchers

are currently comparing acupuncture with Valium in

treating the symptoms of acute alcohol withdrawal, and

are the recipients of the new NIDA cocaine treatment

research grant.

A similar placebo-type study was done at Bayview-Hunter’s

Point Clinic comparing methadone and acupuncture in

the detoxification from heroin. This 3-phase, 11




study was commissioned by the California legislature. A

report to the legislature indicates that acupuncture clients

were more likely to have clean urinalysis and reported

longer periods of abstinence with fewer problem days

than their methadone controls (TRIAD, 1991).

One of the non-criminal-justice speakers at the 1991

NADA Conference was Robert Olander, Commissioner

of Chemical Health for Hennepin County, Minnesota,

and one of the active NIDA researchers there. He

suggested that there have been three “benchmarks”

in the history of alcohol and drug treatment in the

United States, three things that have revolutionized

the way we do alcohol and drug therapy: first was the

founding of Alcoholics Anonymous in 1935; second was

the development of pharmaceuticals in the late 1950s

and early ‘60s, and the third is acupuncture. Whether

acupuncture indeed deserves a place on this exclusive

list remains to be seen. Given the economic and social

devastation of the current drug and addiction problem in

the United States, however, we are perhaps well advised

to reflect upon Rangel’s urging, “to consider it objectively,

with an open mind and without prejudgment.”


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Alex G. Brumbaugh, BA, CAC

Council on Alcoholism and Drug Abuse

Santa Barbara