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
evaluation.
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.
Summary
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
Abstract
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.
Introduction
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.
Methods
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.
Incentives
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
Characteristic
No of Patients
Treatment group
(n = 40)
Control group
(n = 40)
Sex
M
F
37
3
38
2
Marital Status
Married
Single
Widowed
Divorced
Separated
1
15
2
16
6
2
17
1
17
3
Race
White
Native American
Black
Hispanic
26
8
4
1
23
14
2
1
Support person/group
Yes
No
5
35
5
35
On welfare
Yes
No
23
17
27
13
DWI arrests
None
1-4
>4
13
23
4
16
19
5
Other alcohol-related arrests
None
1-10
>10
8
20
12
7
21
12
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
2
:
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
Results
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
Tranquilizers
Sedatives
Opioids
Cocaine
Stimulants
Marijuana
0
2
0
2
4
6
2
0
1
2
2
12
Pattern of Drinking
Daily
Binge
Intermittent
29
9
2
28
8
4
Mean Duration of
Alcohol Abuse (YR)
< 16
16-19
20-24
> 25
Mean
14
12
9
5
19.3
18
10
5
6
17.3
No of Inpatient
Treatment Programme
0-1
2-10
11-20
11
23
6
5
31
4
No of Outpatient
Treatment Programmes
(AA encounters)
0
1-10
10-100
4
33
3
10
25
5
‘Antabuse’ Programmes
0
1-4
>4
8
26
6
10
26
4
Detoxification Centre
Admission*
None
1-10
11-20
> 21
1
29
6
4
3
18
11
8
*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
Strong
Indifferent to
None
One Month
Treatment Group
Control Group
9
14
25
14
Three Months*
Treatment Group
Control Group
12
16
20
9
Six Monthst
Treatment Group
Control Group
5
12
22
10
*p<0.05
t
p<0.01
Table V—Self-Reported Drinking Episodes During Each
Follow Up Interval
Follow-up Interval No of Drinking
Episodes*
Mean (SEM)
Drinking
Episodes
One Month**
Treatment Group (34)
Control Group (28)
107
162
3.15 (1.03)
5.71 (1.29)
Three Months***
Treatment Group (32)
Control Group (25)
101
301
3.15 (0.96)
11.61 (2.31)
Six Monthst
Treatment Group (27)
Control Group (22)
100
241
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
t
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.
Discussion
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
17
5
17
23
Three Monthst
Treatment Group
Control Group
13
3
19
23
Six Monthst
Treatment Group
Control Group
12
4
16
19
*p<0.01
t
p<0.05
Table VII—Admissions to the Detoxification Centre
During Each Follow Up Interval
Follow-up Interval No of
admissions*
Mean (SEM) no
of Admissions
One Month**
Treatment Group (36)
Control Group (31)
25
59
0.62 (0.20)
1.54 (0.32)
Three Monthst
Treatment Group (33)
Control Group (26)
24
65
0.59 (0.17)
1.67 (0.42)
Six Monthst
Treatment Group (29)
Control Group (24)
26
62
0.69 (0.41)
1.56 (0.20)
*Total = 75 for treatment group and 186 for control group
**p < 0.01
t
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.
1. O’Connor J, Bensky D. 1981. Acupuncture, a
comprehensive text (Shanghai College of Traditional
Medicine) Seattle: Eastland Press.
2. Anonymous. Huangdi Neijing (Canon of Medicine;
compiled 500-300 BC) Lu H, translator. Vancouver:
Academy of Oriental Heritage, 1978.
3. Anonymous. Essentials of chinese acupuncture. Beijing:
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.
5. Smith MO, Squires R, Aponte J, Rabinowitz N, Rodriguez
RB. Acupuncture treatment of drug addiction and alcohol
abuse. Am J Acupuncture 1982; 10: 161-63.
6. Kerr P. Acupuncture experiment in New York is said to ease
addiction to crack. New York Times Sept 30 1988, p 9.
7. Kurtz H. Cracking drug addiction. Washington Post Sept
5 1988, p 1.
8. Bullock, M.L., Umen, A.J. Culliton, P.D., Olander, R.T.,
Acupuncture treatment of alcoholic recidivism: a pilot
study. Alcoholism (NY) 1987; 11: 292-95.
9. Steiner RP. Acupuncture-cultural perspectives 1. The
western view. Postgrad Med 1983; 74:60-67.
10. Wen HI., Cheung SYC. Treatment of drug addiction by
acupuncture and electrical stimulation. Asian J Med 1973;
9: 138-41.
11. Wen HI., Teo SW. Experience in the treatment of drug
addiction by electro-acupuncture. Mod Med Asia 1975;
11: 23-24.
12. Wen HI., Acupuncture and electrical stimulation (AES)
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.
15. West LJ, Maxwell DS, Noble EP, Solomon DH.
Alcoholism (UCLA Conference). Ann Intern Med 1984;
100: 405-16.
16. Holden C. Alcoholism and the medical cost crunch.
Science 1987; 235: 1132-33.
17. Miller WR, Hester RK. Inpatient alcoholism treatment:
who benefits? Am Psychol 1986; 41: 794-805.
18. Holden C. Is alcoholism treatment effectiv
Introduction
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
treatment.
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
response.
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
program.
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
Introduction
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
detoxification:
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
interventions.
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.
References
1. Academy of Traditional Chinese Medicine. ( 1975).
An outline of Chinese acupuncture. Peking: Foreign
Language Press.
2. Ackerman, R. (1992). Treating pregnant and
postpartum substance abusing women with acupuncture
for detoxification. preparation for counseling and relapse
prevention. [Video]. (Available from 2417 Castillo St.
Santa Barbara, CA 93105).
3. All-China Society of Acupuncture and Moxibustion.
(1984). The second national symposium on acupuncture
and moxibustion and acupuncture anesthesia. Bejing,
China: Author
4. American Hospital Association (1991). Hospital and
community partnerships: prenatal, infant care, and
pediatric models for underserved women. (Available
from The American Hospital Association, 840 North
Lake Shore Drive, Chicago, IL. 60611)
5. Anglin, M. D. (1989). Alcohol use by heroin addicts:
Evidence for an inverse relationship. American Journal
of Drug and Alcohol Abuse. 15, 191-207.
6. Anglin, M.D., & McGlothlin, W. H. (1985).
Methadone maintenance in California. In L. Brill &
C. Winick (Eds.) The Yearbook of Substance Use and
Abuse, 3 (pp. 219-280). New York: Human Science
Press.
7. Barbor, T. F., Stephens R.S., & Marlatt, G.A.
(1987). Verbal report methods in clinical research
on alcoholism: Response bias and its minimization.
Journal of Studies on Alcohol. 48, (5), 410-424.
8. Becke, H. (1988, October). Dangerous acupuncture
points in pregnancy. Deutsche Zeitschrift fur
Akupunktur, 5. 110-111.
9. Becker, R.O. & Selden, G. (1985). The Body Electric.
New York: William Morrow.
10. Blum, K. (1990). Alcohol and the addictive brain. The
New Free Press News.
11. Blum, K. (1990, September-October). The 'Alcoholic'
Gene. Professional Counselor.
12. Bullock, M.L., Culliton, P.O., & Olander, R.T. (1989,
June 24). Controlled trial of acupuncture for severe
recidivistic alcoholism. The Lancet. 1435-439.
13. Bullock, M.L, Ymen, A.J., Culliton, P.O., & Olander,
R.T. (1987, May-June). Acupuncture treatment of
alcoholic recidivism: A pilot study. Alcoholism: Clinical
and Experimental Research, 11(3), 292-295.
14. Chao, C.B., Smith, M.O., & Davidson, R. (1989).
Evaluation of the effectiveness of acupuncture on maternal
substance abuse clients. New York: New York City
Department of Health, Health Research Training
Program.
15. Chaudron, C., & Wilkinson, D. (Eds.) (1988).
Theories on Alcoholism. Toronto: Addiction Research
Foundation.
16. Cheng, R.S., & Pomeranz, B. (1979). 36 National Acupuncture Detoxification Association
Electroacupuncture analgesia could be mediated by at
least two pain-relieving mechanisms: Endorphin and
non-endorphin systems. Life Sciences, 2. 1957 -1962.
17. Clark, W. (1990, August 15). Trial of acupuncture
detoxification (TRIAD) Final report. (Available from
California State Legislature )
18. Clement-Jones, V., McLoughlin, L., Lowry, P.J.,
Bresser, G.M., Rees, L.H., & Wen, H.L. (1979).
Acupuncture in heroin addicts: Changes in
metenkephalin and beta-endorphin in blood and
cerebrospinal fluid. Lancet 2, 380-383.
19. Cocchi, R.t Lorini, G., Fusari, A. & Carrossino, R.
(1979). Experience with detoxification and weaning
of heroin addicts by means of acupuncture, gabergic
drugs and psychopharmalogic agents in low doses.
Minerva Med. 70(24), 1735-1744.
20. Colvin, M. (1983, January - June). A counseling
approach to outpatient benzodiazapine detoxification.
Journal of Psychoactive Drugs. 15( 1-2), 105-108.
21. Cosser, M.H., Brower, KJ., & Bersford, T.P. (1990,
April). Treatment of alprazolam withdrawal with
substitution and gradual reduction of chloridazepoxide.
Paper presented at the annual meeting of the American
Society for Addiction Medicine, Phoenix, AZ.
22. Cregler, L.L. & Mark, H. (1986). Medical
complications of drug abuse. New England Journal of
Medicine. 315, 1495-1500.
23. Dackis, C.A. & Gold, M.S. ( 1985). New concepts
in cocaine addiction: The dopamine depletion
hypothesis. Neuroscience and Bio-Behavioral Reviews.
9. 469-477.
24. Dackis, C.A., Gold, M.S., Sweeney, D.R., Byron,
J.P., & Climko, R. (1987). Single dose bromacriptine
reverses cocaine craving. Psychiatric Research. 20. 261-
264.
25. Darras & De Vernejoul. (1986). Visualization of
acupuncture pathways. World Research foundation
Congress of Bio-Energetic Medicine. Los Angeles.
Video Tape.
26. Diamond, E. (1971). Acupuncture anesthesia. Journal
of American Medical Association, 218. 1558-1563.
27. Donovan, D. & Marlatt, G. (1988). Assessment of
Addictive Behaviors. NY: Guildford Press.
28. Donovan, D. (1988). Assessment of addictive
behaviors: Implications of an emerging biopsychosocial
model. In D. Donovan & G. Marlatt (Eds.) Assessment
of addictive behaviors (pp. 3-50). New York: Guilford
Press.
29. Dumitrescu, I., & Kenyon, J. (1983). Electrographic
imaging in medicine and biology. Sudburry, Suffolk,
Great Britain: Neville Spearman Limited.
30. Fetzer Foundation. (1989). Energy fields in medicine:
A study of device technology based on acupuncture
meridians and chi energy. Kalamazoo, MI: John E.
Fetzer Foundation.
31. Fingerette, H. (1988). Heavy drinking. Berkeley:
University of California Press.
32. Finnegan, LP., Connaughton, J.F., Emich, J.P. &
Wieland, W.F. (1972). Comprehensive care of the
pregnancy addict and its effect on maternal and infant
outcome. Contemporary Drug Problems: It 794-81
33. Fitzgerald, K. W. (1988). Alcoholism: The genetic
inheritance. NY: Doubleday.
34. Ford-Geiger, E. (1986). The psychotherapeutic
utilization of acupuncture. (Doctoral dissertation,
University of Massachusetts.
35. Frances, R. (1989). Concise Guide to Treatment
of Alcoholism and Addictions. Washington, D.C.:
American Psychiatric Press.
36. Frawley, P.J. (1990, April 23). Private sector research
studies on alcoholism treatment. Paper presented at
the meeting of the American Society of Addiction
Research Medicine Symposium, Phoenix, AZ.
37. Gawin, F. H. (1988). Chronic neuropharmacology
of cocaine: Progress in pharmacotherapy. Journal of
Clinical Psychiatry. 49, 11-16.
38. Gawin, F.H., & Ellinwood, E., Jr. (1988). Cocaine
and other stimulates: Action, abuse and treatment.
New England Journal of Medicine. 318. 1173-1182.
39. Gawin, F.H., & Kleber, H.D. (1986b). Medical
management of cocaine withdrawal. New Haven, CT:
APT Foundation.
40. Geerlings, P.J., Bos, T.W., Schakin, H.F., & Wouters,
L.F. (1985). Detoxification of heroin addicts with
electrostimulation or methadone. Tijdschrift Voor
Alcohol, Drugs, En Andere Psychotrope Stoffen. 11 (2),
80-85.
41. Gold, M.S., Washton, A., & Dackis, C.A. (1985).
Cocaine abuse, neurochemistry, phenomenology
and treatment. In N.J. Kozel & E.H. Adams (Eds.).
Cocaine use in America: Epidemiologic and clinical
perspectives. (NIDA Research Monograph No. 61.)
U.S. Government Printing Office, Washington D.C.
42. Goleman, D. (1990, July 7). Drug addiction linked to
brain irregularities. Santa Barbara News Press. p. A15.
43. Gomez, E. & Mikhail, A. (1974). Treatment of
methadone withdrawal with cerebral electrotherapy
(electrosleep) Paper presented at the annual meeting of
the American Psychiatric Association, Detroit, MI.
44. Han, J., Li, S., & Tang, J. (1981). Tolerance to
electroacupuncture and its cross tolerance to
morphine. Neuropharmacology. 6, 593-596.National Acupuncture Detoxification Association 37
45. Han, J., Tang, J., Huang, B., Liang, X. & Zhang, N.
(1979). Acupuncture tolerance in rats: Antiopiate
substrate implicated. Chinese Medical Journal 9(9),
625-627.
46. Hayshiada, M., Alterman, A., McLellan, T., O'Brien,
C., Purtill, J., Volpicelli, J., Raphaelson, A. & Hall,
C. (1989, February 9). Comparative effectiveness and
costs of in-patient and out-patient detoxification of
patients with mild to moderate alcohol withdrawal
syndrome. New England Journal of Medicine, 320(6),
358-365.
47. Heggenbougen, H.K. (1984). Traditional medicine
and the treatment of drug addicts: 3 examples from
Southeast Asia. Medical Anthropology Quarterly,
16(1), 3-7.
48. Jacobs, S., Anderson, G., Bailey, S., Ottaviano, J. &
McCarthy, V. (1977). Neurophysiological correlates
of acupuncture: Limbic and thalamic responses to
analgesic studies in nonhuman primates. Journal of
Life Sciences. 7(3), 37-42.
49. Jaffe, J.H. (1985). Drug addiction and drug abuse. In
A. Goodman, L.S. Goodman, & Y. Gilman (Eds.) The
Pharmacological Basis of Therapeutics. 7th ed. (pp.550-
554). New York: MacMillan.
50. Kao, A. H. & Lu, L.Y.C. (1974). Acupuncture
procedure for treating drug addiction. American
Journal of Acupuncture. 2: 201-207.
51. Kaptchuk, T. (1983). The web that has no weaver:
Understanding Chinese medicine. New York: Congdon
and Weed.
52. Katims, J.J., Ng, L.K.Y., & Lowinson, J.H. (1992).
Acupuncture and transcutaneous electrical nerve
stimulation: Afferent nerve stimulation (ANS) in the
treatment of addiction. In J. H. Lowinson, P. Ruiz,
R.B. Millman & J. G. Langrod (Eds.), Substance abuse:
A comprehensive textbook (pp. 574-583). Philadelphia:
Williams & Wilkins.
53. Kaufman, E., & McNaul, I. P. (1992). Recent
development in understanding and treating drug
abuse and dependence. Hospital and Community
Psychiatry, 43 (3), 223-236.
54. Keenan, P. (1990, February). Treatment of pregnant
substance abusers. Paper presented at the National
Acupuncture Detoxification Association Conference,
Research Subsection, Miami, Florida.
55. Kenyon, J. (1983). Modern technologies of acupuncture,
volume 2: A practical scientific guide to electroacupuncture.
New York: Thorsons Publishers Limited.
56. Kleber, H. (1977). Detoxification from methadone
maintenance: The state of the art. International Journal
of Addiction. 12, 897-920.
57. Kleber, H.D. & Riordan, C.E. (1982, June). The
treatment of narcotic withdrawal: Historical review.
Journal of Clinical Psychiatry 43. 30-34.
58. Konefal, J. (1989, March 10). Drug abuse detoxification
study for risk behavior of AIDS. Grant application to the
Department of Health and Human Services, Public
Health Service. (Available from Dept. of Psychiatry,
University of Miami, Miami, FL)
59. Konefal, J. (1990, September). Acupuncture program
services: Mid-year progress report — 1990. (Available
from University of Miami, School of Medicine, Dept.
of Psychiatry, Miami, FL)
60. Kosten, T. R. (1989, July). Pharmacotherapeutic
interventions for cocaine abuse: Matching patients to
treatment. J. of Nervous and Mental Disease, 177 (7),
379-389.
61. Kosten, T.R., Kleber, H.D. & Morgan C. (1989).
Treatment of cocaine abuse with buprenorphine.
Biologic Psychiatry. 26. 637-639.
62. Kroening, R.J., & Oleson, T.D. (1985). Rapid
narcotic detoxification in chronic pain patients treated
with auricular electroacupuncture and naloxone. The
International Journal of the Addictions, 20.(9), 1347-
1360.
63. Kroger, W.S. (1973). The scientific rationale for
acupunctural analgesia. Psychosomatics 14(4), 191-
194.
64. Lane, C.A. (1988). Final evaluation report: Acupuncture
detoxification research demonstration project. (Available
from Alcohol and Drug Program, Multnomah
County, Oregon)
65. Lau, M.P. (1976). Acupuncture and addiction: An
overview. Addictive Diseases, L449-463.
66. Lei, C. (1973). Neurological basis of pain and its
possible relationship to acupuncture analgesia.
American Journal of Chinese Medicine. 1, 61-72.
67. Leung, A.J.H. (1977). Acupuncture treatment
and withdrawal symptoms. American Journal of
Acupuncture, 5. 43-50.
68. Lewenberg, A. ( 1985). The utility of acupuncture in
combination with antidepressants or clonidine in the
treatment of opiate addiction. Advances in Therapy.
2(4), 143-149.
69. Liao, Y.Y., Seto, K., Saito, H., Fugita, M., &
Kawakami, M. (1979). Effects of acupuncture on
adrenocortical hormone production: I. Variation
in the ability for adrenocortical production for the
duration of acupuncture stimulation. American
Journal of Chinese Medicine.( 4), 362-371.
70. Lipton, D.S., & Miranda, M.J. (1983). Detoxification
from heroin dependency: an overview of method and
effectiveness. Evaluation of Drug Treatment Programs. 38 National Acupuncture Detoxification Association
(pp. 31-55). New York: The Haworth Press.
71. Lipton, D.S., Brewington, V. de Smith, M.O. (1990).
Acupuncture and crack addicts: A single blind placebo
test of efficacy. Paper presented at the National Institute
on Drug Abuse (NIDA). Technical review meeting,
Advances in Cocaine Treatment. National Institutes
of Health Campus. Bethesda, MD.
72. Lorini, G., Fazio, L., Cocchi, R.t Fusari, A. & Roccia,
L. (1979). Acupuncture as a part of a program of
detoxification and weaning from opiates: 25 cases.
Minerva Medica. 70(56), 3831-3836.
73. Lowinson, J. H., Ruiz, P. Millman, R. B., & Langrod,
J. G. (Eds.). (1992). Substance abuse: A comprehensive
textbook. Philadelphia: Williams & Wilkins.
74. Macek, C. (1984, January 27). East meets west to
balance immunologic yin and yang. JAMA. 251(4),
433-439.
75. MacQuarrie, L. (1974). In Hong Kong, acupuncture:
It still has a place. J. of Addictions Research Foundation
of Ontario. 3 (11) 10.
76. Man, P.L., & Chuang, M. Y. (1980). Acupuncture
in methadone withdrawal. International Journal of
Addiction. 15. 921-926.
77. Mann, F. (1973). Acupuncture: The ancient Chinese art
of healing and how it works scientifically. New York:
Vintage Books.
78. Mayer, D.J., Price, D.O., & Raffi , A. (l977).
Antagonism of acupuncture and analgesia in man by
the narcotic antagonist naloxone. Brain Research. 121,
368-372.
79. McLellan, A., Luborsky, L., O'Brien, C., & Woody,
G. (1980). An Improved Evaluation Instrument for
Substance Abuse Patients: The Addiction Severity
Index. Journal of Nervous and Mental Diseases, 1968.
26-33.
80. Morley, J. (1990, November-December). The War
on Crack: Deescalating the War. Family Therapy
Networker, 14 (6), 24-36.
81. Moyers, W. (1993). Healing and the mind. NY:
Doubleday.
82. Navach, J. (1989). Thermodynamic, biochemical
and electromagnetic views of chi. Energy Fields in
Medicine: A Device Technology Based on Acupuncture
Meridians and Chi Energy, 193 .. 122. The John E.
Fetzer Foundation, 929 West KL Avenue, Kalamazoo,
Michigan 49009.
83. Newmeyer, J.A., Johnson, G., & Klot, S. (1984, JulySeptember).
Acupuncture as a detoxification modality.
Journal of Psychoactive Drugs, 16(3), 241-261.
84. Ng, L.K.Y., Donthill, T.C., Thoa, N.B. & Albert,
C.A. (1975a). Modification of morphine syndrome
in rats following transauricular electrostimulation:
An experimental paradigm for auricular
electroacupuncture. Biological Psychiatry, 10. 575-
580.
85. Ng, L.K.Y., Thoa, N.B, Donthill, T.C., & Albert, C.A.
(197Sb). Experimental "auricular electroacupuncture"
in morphine dependent rats: behavioral and
biochemical observations. American Journal of Chinese
Medicine. 3, 335-341.
86. Nogier, P.F.M. (1983). From Auriculotherapy
to Auriculo-medicine. Sainte-Ruffine, France:
Maisonneuve.
87. Omura, Y. (1976). Patho-physiology of acupuncture
effects, ACTH and brain morphine-like substances,
pain, phantom sensations (phantom pain, itch and
coldness), brain micro-circulation, and memory.
Acupuncture and Electrotherapeutics Res. International
Journal, 2, 1-31.
88. Omura, Y. (1978). Pain threshold measurement
before and after acupuncture. Acupuncture and Electro
Therapeutic Research. 3, 1-22.
89. Patterson, M.A. (1974). Electroacupuncture and
alcohol and drug addictions. Clinical Medicine. 81,
9-13.
90. Patterson, M.A. (1976). Effects of neuroelectric
therapy (N.E.T.) in drug addiction: Interim report.
Bulletin of Narcotics. 28, 55-62.
91. Patterson, M.A. (1991). Neuroelectric therapy: the new
approach to drug treatment and its scientific basis. Paper
presented at the first annual meeting of the Subtle
Energies and Energy Medicine Society. (pp. 76-79)
Available from the International Society for the Study
of Subtle Energies and Energy Medicine. First Annual
Conference. June 21-25, 1991. Boulder, CO)
92. Peets, J.M. & Pomeranz, B. (1978). CXBK-mice
deficient in opiate receptors show poor electroacupuncture
analgesia. Nature. 273, 675-676.
93. Peng, C.H., Yang, M.M., Kok, S.H., & Woo, Y.K.
(1978). Endorphin release: A possible mechanism of
acupuncture analgesia. Comparative Medicine East and
West. 6( 1), 57-60.
94. Pert, A., Dionne, R., Ng, L.t Bragin, E., Moody,
T.W. & Pert, C.B. (1981). Alterations in rat central
nervous system endorphins following transauricular
electroacupuncture. Brain Research. 224, 83-93.
95. Pittman, L. ( 1992). Acupuncture detoxification for
homeless substance abusers. Report for the Department
of Human Resources, Jersey City, NJ.
96. Pomeranz, B. & Chieu, D. (1976). Naloxone blockade
of acupuncture analgesia: Endorphin implicated. Life
Sciences. 19. 1757-1762.National Acupuncture Detoxification Association 39
97. Pomeranz, B. (1981). Neural mechanisms of
acupuncture and analgesia. In S. Lipton & J. Miles
(Eds.). Persistent Pain, Modern Methods of Treatment.
(pp. 241-257). London: Academic Press.
98. Pomeranz, B. (1987). Acupuncture neurophysiology.
In G. Adelman (Ed.) Encyclopedia of Neuroscience. 1
(pp. 6-7). Boston: Brikhauser.
99. Resnick, R. (1983). Methadone detoxification from
illicit opiates and methadone maintenance. New York
College Division of Drug Abuse and Treatment,
National Institute on Drug Abuse: Treatment and
Research Monographs, (No. 83-1281), 160-167.
100.Sachs, L.L. (1975). Drug addiction, alcoholism,
smoking, obesity treated by auricular staplepuncture.
American Journal of Acupuncture, 3, (2), 147-150.
101.Sainsbury, M.J. (1974). Acupuncture in heroin
withdrawal. Medical Journal of Australia. 3, 102-105.
102."Scientists say enzyme could combat cocaine" (1993,
March 26). Santa Barbara News Press.
103.Severson, L., Markoff, R.A. & Chun-Hoon, H.
(1977). Heroin detoxification with acupuncture
and electrical stimulation. International Journal of
Addiction, 12, 911-922.
104.Shaffer, H. ( 1986). Conceptual crises and the
addictions: Philosophy of science perspective. Journal
of Substance Abuse Treatment. 3. 285-296.
105.Shaiub, M. (1976). Acupuncture treatment of drug
dependence in Pakistan. American Journal of Chinese
Medicine. 4, 403-407.
106.Shakur, M., & Smith, M. (1979). The use of
acupuncture in the treatment of drug addiction.
American Journal of Acupuncture, 7. 223-234.
107.Shanghai College of Traditional Medicine. (1981).
Acupuncture: A comprehensive text. J. O'Connor & D.
Bensky, (Eds.). Chicago: Eastland Press.
108.Shaowanasai, A. & Visuthima, H. (1975). Acupuncture
and the treatment of heroin addiction. Paper presented
at the 31st International Congress on Alcoholism and
Drug Dependence: Bangkok, Thailand.
109.Shaowanasai, A. (1975). Report on acupuncture
detoxification in Mauritius. In P. Bourne (Ed.).
Acupuncture and the Detoxification of Opiate Addicts.
Unpublished report. Washington, D.C.: Drug Abuse
Council.
110.Smith, M. (1987). Acupuncture Treatment for
Substance Abuse. (Available from Lincoln Hospital
Division of Substance Abuse, 349 East 140th Street,
Bronx, NY 10454)
111.Smith, M. (1989a, November). The Challenge
of Treating Maternal Substance Abuse. National
Acupuncture Detoxification Association, 3115
Broadway #51, New York, New York 10027.
112.Smith, M. O. (1989b, July 5). The Lincoln Hospital
Drug Abuse Program. Testimony Presented to the
Select Committee on Narcotics of the House of
Representatives of the United States. Washington,
DC.
113.Smith, M.O., Alvarez, C. & Smalls, N. (1987,
September 10). Criminal justice referrals to acupuncture
detoxification: Pilot program shows encouraging results.
(Available from Substance Abuse Division, Lincoln
Hospital, Bronx, NY)
114.Smith, M.O. (1979). Acupuncture and natural
healing in drug detoxification. American Journal of
Acupuncture, 7. 97-107.
115.Smith, M.O. (1985). Chinese theory of acupuncture
detoxification. American Journal of Acupuncture.
13(4), 386-387.
116.Smith, M.O. (1988a, April 11). Acupuncture as a
treatment for drug dependent mothers. Testimony
presented to the New York City Council, New York,
NY.
117.Smith, M.O. (1988b). Acupuncture treatment for
crack: clinical survey of 1,500 patients. American
Journal of Acupuncture. 16(3), 241-247.
118.Smith, M.O. (1988c). The pregnant substance abuser:
Recognizing and treating the patient. (Available from
March of Dimes Birth Defect Foundation. Greater
New York Chapter, 233 Park Avenue South, NewYork,
New York 10003)
119.Smith, M.O. (1990a, September). NADA Newsletter.
1-3. (Available through Lincoln Hospital, Maternal
Substance Abuse Services. 349 East 140th Street,
Bronx, New York 10454.)
120.Smith, M.O. (1990b, September). The Miami success
story: Transforming the criminal justice system with
an acupuncture based diversion program. National
Acupuncture Detoxification Association Newsletter,
Available from NADA, 3115 Broadway, #51, New
York, New York 10027, 1-3.
121.Smith, M.O. (1990c). Raising Healthy Babies for the
90's. (Available through Lincoln Hospital, Maternal
Substance Abuse Services. 349 East 140th Street,
Bronx, New York 10454)
122.Smith, M.O., & Khan, I. (1988). An acupuncture
programme for the treatment of drug-addicted
persons. Bulletin on Narcotics. XL(1), 35-41.
123.Smith, M.O., & Ra, K. (1985, July 22-26).
Acupuncture and the treatment of chemical dependency
and violence. Paper presented at the Caribbean Mental
Health Conference, Nassau, Bahamas.
124.Smith, M.O., Squires, R., Aponte, J., Rabinowitz, 40 National Acupuncture Detoxification Association
N., & Bonilla-Rodriguez, R. (1982). Acupuncture
treatment of drug addiction and alcohol abuse.
American Journal of Acupuncture. 10(2), 161-163.
125.Smith, R. B., O'Neil, L.A. (1975). Electrosleep in the
management of alcoholism. Biological Psychiatry, 10
(B), 675-680.
126.Spencer, C.P., Heggenbougen, H.K., & Navaratam,
V. (1980). American Journal of Chinese Medicine 8(3),
230-238.
127.Summer, G.L. (1990, April). Cocaine treatment: The
first twelve months. (Available from Hanley-Hazelden
Center, St. Mary's Hospital, P. O. Box 4424, West
Palm Beach, FL 14302)
128.Tennant, F.S. (1977). Outpatient heroin detoxification
with acupuncture and staplepuncture. Western Journal
of Medicine, 125, 141-144.
129.Trachtenberg, M. and Blum, K. (1988). Improvements
of cocaine induced neuromodulator deficits by the
neuronutrient Tropamine. Journal of Psychoactive
Drugs, 20(3), July-September.
130.Wallace, J. (1989,June). A biopsychosocial model of
alcoholism. Social Casework. 70(6), 325-332.
131.Washburn, A.N., Keenan, P.A., & Nazareno, J.P.
(1990). Preliminary findings: Study of acupuncture
assisted detoxification. MIRA Newsletter. (Available
from Bay View Hunters Point Foundation for
Community Improvement, U.C.S.F. Center for Aids
Prevention Studies, P.O. Box 0886, University of
California, San Francisco, CA 94143)
132.Wen, H.L. & Cheung, S. Y.C. (1973). Treatment
of drug addiction by acupuncture and electrical
stimulation. Asian Journal of Medicine, 9. 138-141.
133.Wen, H.L. (1977). Fast detoxification of heroin
addicts by acupuncture and electrical stimulation
(AES) in combination with naloxone. Compo Med.
East-West. 5, 257-263.
134.Wen, H.L. (1980, Winter). Clinical experience and
mechanisms of acupuncture and electrical stimulation
(AES) in the treatment of drug abuse. American
Journal of Chinese Medicine, 8(4), 349-353.
135.Wen, H.L, & Teo, S.W. (1974). Experience in the
treatment of drug addiction by electroacupuncture.
Modern Medicine of Asia, 11, 23-24.
136.Wen, H.L., Ho, W.K., Wong, H.K., Mehal, Z.O., Ng,
Y.H. & Ma, L (1979). Changes in adrenocorticotropic
hormone (ACTH) and cortisol levels in drug addicts
treated by a new and rapid detoxification procedure
during acupuncture and naloxone. Comp Med EastWest.
6(3), 241-245.
137.Wen, H.L., Ho, W.K.K., Ling, N., Ma, L. & Choa,
G.H. (1979). The influence of electroacupuncture on
naloxone induced morphine withdrawal. II. Elevation
of immunoassayable beta-endorphin activity in the
brain but not in the blood. American Journal of Chinese
Medicine, 7(3), 237-240.
138.Wen, H.L, Ho, W.K.K., Wong, H.K., Mehal,
Z.O., Ng, W.H. & Ma, L. (1978). Reduction of
adrenocorticotropic hormone (ACTH) and corticol
and drug addicts treated by acupuncture and electrical
stimulation. Compo Med.East-West, 61-66.
139.Whitehead, O. (1978). Acupuncture and the
treatment of addiction: A review and analysis.
International Journal of Addictions, 13(1), 1-16.
140.Wu, C. & Hsu, C. (1979). Neurogenic regulation of lipid
metabolism in the rabbit. Atherosclerosis, 33,153-164.
141.Zuckerman, B. & Alpert, J. (1988, March 9).
Commentary: Alcohol and psychoactive drug use
during pregnancy. Pediatrics in Re
Abstract
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
/
2
year
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.”
References
1. Ackerman. R. (1991). Acupuncture detoxification for
pregnant substance abusers. (Available from Project
Recovery, Santa Barbara Council on Alcoholism and
Drug Abuse. P.O. Box 28, Santa Barbara. CA 93102)
2. Bensoussan, A. (1990). The vital meridian. Edinburgh:
Churchill Livingstone.
3. Brecher, E.M. (1972). Licit and Illicit Drugs: The Consumer
Union Report. Boston: Little, Brown.
4. Brumbaugh. A. (1992). Acute care program: First year
report. (Available from Project Recovery, Santa Barbara
Council on Alcoholism and Drug Abuse, P.O. Box 28.
Santa Barbara, CA 93(02)
5. Brumbaugh, A., & Wheeler, S. (1991). Six month jail
demonstration project: A preliminary analysis. (Available
from Project Recovery. Santa Barbara Council on
Alcoholism and Drug Abuse. P.O. Box 28. Santa Barbara.
CA 93102)
6. Bullock, M., Culliton. P, & Olander. R. (1989).
Controlled trial of acupuncture for severe recidivistic
alcoholism. Lancet, 143S-1439.
7. Childress. A.R., McLellan, A.T., Natale. M., & O’Brien,
C.P. (1986). Mood states can elicit conditioned withdrawal
and craving in opiate abuse patients (National Institute
on Drug Abuse Research Monograph Series, No. 76).
Washington, DC: U.S. Government Printing Office.
8. Cregler, L. & Mark, H. (1986). Medical complications
of drug abuse. New England Journal of Medicine, 315.
149S-ISOO.
9. DHHS. (1991). Drug abuse and drug abuse research: The
third triennial report to CongressJrom the Secretary. U.S.
Department of Health and Human Resources (DHHS
Publication No. ADM 91-1704).
10. Egertson. J.A. (1991, February 4). Chief, Government
and Constituent Relations Branch, National Institute on
Drug Abuse. Memorandum to Rod Weich. United States
Congress.
11. Gorski, T. (1987). Staying sober-A guide to relapse
prevention. New York: Harper and Row.
12. Kaptchuk. T. (1983). The web that has no weaver. New
York: Congdon and Weed.
13. Keenan, P. (1991). Treatment for babies in the face of
the crack epidemic. MIRA: The Quarterly Newsleuer
of Multicultural Inquiry and Research on AIDS, 5 (2).
(Available from MIRA, S81S 3rd Street, San Francisco
CA 94124)
14. Konefal, J. (1990). Acupuncture program services:
Mid-year progress report. (Available from University
of Miami. School of Medicine, Department of
Psychiatry, P.O. Box 016069. Miami FL 33101)50 National Acupuncture Detoxification Association
15. Kurtz, E. (1979). Not God—A history of Alcoholics
Anonymous. Center City, MN: Hazelden Press.
16. Lane, C. (1988). Final evaluation report: Acupuncture
Detoxification Project, Hooper Center. Central City
Concern, Multnomah County, Oregon. Alcohol and
Drug Program.
17. Lipton, D.S., Brewington, V., & Smith. M. (1990).
Acupuncture and crack addicts: A single-blind placebo
test of efficacy (NIDA Grant No.1 ROI DAOS632-01;
available from Narcotic and Drug Research. Inc., 11
Beach Street, New York, NY 10010).
18. Man, C. (1972a). Mechanisms of acupunctural anesthesia:
The two gate control theory. Diseases of the Nervous System,
33, 730-73S.
19. Man, C. (l972b). Acupuncture “anesthesia”: A new theory
and clinical study. Current Therapeutic Research, 14, 390-
394.
20. McPeake, J.D. et al. (1991). Altered states of consciousness
therapy: A missing component in alcohol and drug
rehabilitation treatment. Journal of Substance Abuse
Treatment, 8. 75-82.
21. Melzack. J.R. (1973). How acupuncture can block pain.
Impact of Science on Society. UNESCO, 13. 6S.
22. Melzack. J.R. (1974). Acupuncture analgesia: A
psychophysiological explanation. Minnesota Medicine, 57,
161-166.
23. NAPARE. (1989). Substances most commonly abused
during pregnancy and their risks to mother and baby.
National Association for Perinatal Addiction Research and
Education Newsletter, Chicago.
24. Nogier, P.F.M. (1983). From auriculotherapy to
auriculomedicine. Sainte-Ruffine. France: Maisonneuve.
25. OTI. (1990). Summary statement for Application
Number: 1 H8ITI 00112-0103 by the Office of Treatment
Improvement, United States Department of Health and
Human Services,to Santa Barbara County Drug and
Alcohol Program, cover letter dated September 21, 1990.
26. Porkert, M., & Ullman. C. (1988). Chinese Medicine-Its
history, philosophy and practice (translated and adapted by
Mark Howson). New York: William Morrow.
27. Puccio, P.S. (1991). Acupuncture detoxification and
relapse service: A concept paper. New York: New York Slate
Division of Substance Abuse Services.
28. Rangel. C. (1990, July 11). Chairman. United States
House of Representatives Select Committee on
Narcotics Abuse and Control, letter to Beny J. Primm,
M.D., Associate Administrator, Office of Treatment
Improvement. ADAMHA.
29. Seymour, R., & Smith, D.E. (1987). Drugfree. New York:
Sarah Larin Books.
30. Smith, M. (1979). Acupuncture and natural healing in
drug detoxification. American Journal of Acupuncture, 2,
7, 97-106.
31. Smith, M. (1988). Acupuncture treatment for crack:
Clinical survey of 1.500 patients. American Journal of
Acupuncture. 16. 241-247.
32. Smith. M. & Kahn, I. (1988). An acupuncture programme
for the treatment of drug addicted persons. Bulletin on
Narcotics, 40, 35-41.
33. Smith, M. (1990). Raising healthy babies for the 90’s.
(Available through Lincoln Hospital, Maternal Substance
Abuse Services. 349 East I40th Street. Bronx NY 10454)
34. Sodipo, J., & Falaiye, J. (1979). Acupuncture and gastric
acid studies. American Journal of Chinese Medicine. 7,356-
361.
35. TRIAD. (1991). Trial of acupuncture detoxification:
Final report (Delivered to California State Legislature).
36. Wall, P.O. (1978). The gate control theory of pain
mechanisms; a re-examination and restatement. Brain,
101, 1-18.
37. Wen, H.L.. & Cheung, S.Y.C. (1973). How acupuncture
can help addicts. Drugs and Society, 2, 8-18.
Alex G. Brumbaugh, BA, CAC
Council on Alcoholism and Drug Abuse
Santa Barbara
