The Use of Acupuncture in Drug Addiction Treatment |
GUEST COLUMNSeptember 1995 |
Alternative medicine in the United States is a billion-dollar industry. A 1993 study published in The New England Journal of Medicine found that the American public spent almost as much out of pocket money on alternative medicine in 1990 ($10.3 billion) as they did on hospitalizations ($12.8 billion). In fact, the study estimated that people made more visits to unconventional therapy providers (425 million) than they did to primary care physicians (388 million).[1] Viewed with skepticism by some, and virtually unknown to many, alternative medical techniques deserve serious attention.[2]
Acupuncture, now one of the most popular forms of alternative medicine, was virtually unknown in the United States until recently.[3] In 1971, James Reston, one of the New York Times' most respected journalists, was traveling in China when he was stricken with acute appendicitis. His subsequent article on the use of acupuncture as an anesthetic turned his misfortune into the spark of much Western interest in acupuncture and other Chinese medicines.[4]
Serious medical research and experimentation with the healing powers of acupuncture has led to the discovery of a highly promising weapon in the fight against chemical dependency. Though there is a consensus in the medical community that more reliable scientific data on the subject need to be collected, anecdotal evidence and clinical success stories strongly suggest that acupuncture can alleviate many of the serious symptoms of withdrawal, thus facilitating detoxification and encouraging acute addicts to continue treatment.
Recent enthusiasm for acupuncture treatment has encouraged some detoxification clinics to incorporate it into their programs. Court systems in several major cities have created "drug courts," in which a program of intensive counseling and treatment, sometimes including acupuncture, is substituted for traditional prosecution. The need for more effective approaches in dealing with repeat drug offenders, combined with the relatively low cost of maintaining clients in drug court programs, makes some law enforcement officials hopeful that acupuncture will be an effective part of the solution for addicts who find the lure of substance abuse more powerful than the threat of incarceration.
The aims and approaches of Chinese medicine are utterly unlike those of Western medicine, which presents a major barrier in attempting to synthesize acupuncture and contemporary American addiction treatment. The radically different nature of the Chinese approach to healing makes many Western observers skeptical of the entire process; others expect a miracle cure that acupuncturists themselves do not promise.
A technical review on the subject of acupuncture use in detoxification programs, sponsored by the National Institute on Drug Abuse (NIDA) in 1991, stated the problem this way:
It is clear that some of the reasons for the wide divergence of opinion regarding the efficacy of acupuncture result from the non-standard terminology used to describe it, the wide range of procedures that have been called acupuncture, the lack of a clear mechanism to explain the purported benefits of acupuncture treatment and perhaps most importantly, the lack of systematic clinical research in this area.[5]
It is important for practitioners of Western medicine, therefore, to understand the underlying theory of acupuncture before it can have a practical application in detoxification clinics and drug courts.
In the language of Chinese medicine, acupuncture is the stimulation of "Qi" (pronounced "chee"), by the insertion of needles into "meridians," or vein-like routes under the surface of the skin. Both Qi and the meridias that carry it are invisible. There is no true English translation for Qi, but "vital energy" is often used.[6] When functioning normally, Qi warms and protects the body, smooths the various transitions of the body from one state to another, and governs retention of the body 's substances and organs.[7] Traditional Chinese medicine functions under the assumption that sickness is caused by the inability of Qi to flow freely through meridians. Acupuncture needles unblock the meridians and stimulate the flow of Qi.[8]
In spite of the fact that Qi is a concept not widely accepted outside the world of Chinese medicine, a number of modern developments have helped to synthesize the collected wisdom of Chinese medicine with Western diagnostic techniques, increasing Western acceptance of acupuncture. Recent research suggests, for example, that the insertion of acupuncture needles stimulates the body's production of beta-endorphins.[9] If this is true, the concept of an invisible life-force flowing through invisible pathways seems like a traditional explanation for a then-unknown physiological process.
Another important discovery occured in 1955, when French doctor Paul Nogier was testing for electrical activity on the skin's surface and found that every traditional acupuncture point on the body has a corresponding point on the human ear.[10] Since that discovery, auricular acupuncture, or needle stimulation of points on the ears, has become by far the most popular method of treatment. In the case of drug detoxification, auricular treatment offers the advantage of not requiring privacy, so that many people can be treated at once in the same room.[11]
Today there is debate about the most effective way to administer acupuncture, from the number of needles to their placement in the ear. The 1991 NIDA technical review came to the conclusion that in the interest of uniformity, controlled research conducted in the future should involve five needles in each ear, placed in the traditional acupuncture points: "kidney," "lung," "liver," "sympathetic," and "shenmen."[12] The panel found no reason to experiment with electrically charged needles, single-ear treatments, or deviations from the standard detoxification points.
Acupuncture is widely accepted by medical professionals in the United States as a safe treatment for chronic pain.[13] Other applications for acupuncture, such as relief of asthma, arthritis, nausea, and morning sickness are being explored by the scientific community.[14] In the case of drug addiction, conclusive scientific evidence of acupuncture's efficacy is scarce.
A 1989 study published in the British journal The Lancet by Milton L. Bullock concluded that acupuncture was highly effective in treating alcoholism. Eighty severe recidivist alcoholics were treated, receiving either correct-point acupuncture or acupuncture at non-specific points on the ear. 21 of the 40 treatment group patients completed the two-month program, while only one of 40 in the control group did. The control group patients experienced twice as many relapses in the six months following the experiment and the number of control group patients admitted to detoxification centers was well over twice that of treatment group patients.[15]
One analysis of the available research on acupuncture as part of a detoxification protocol published in the Journal of Substance Abuse Treatment called the results of the Bullock study encouraging. The analysis also cited seven experiments done on animals in which acupuncture effectively reduced withdrawal symptoms. Though the authors of this analysis are confident that acupuncture has more than a placebo effect, they suggest further research to confirm such findings.[16]
Though the Bullock study is promising, its reliability has been questioned. The NIDA technical review noted that a similar experiment performed in 1992 showed no significant difference between the true acupuncture and sham acupuncture groups. After a review of all existing studies with a similar focus, it found no conclusive proof that acupuncture is more effective than placebo in treating drug addiction.[17] Nevertheless, the review panel suggested that more research be performed in the area.
Acupuncture practitioners are reluctant to make broad, sweeping claims about their work. "I stop short of saying acupuncture is a panacea and can cure everything, because it's not and it can't," said Dr. Ken Carter, a psychiatrist and acupuncturist who works in a pre-trial detoxification clinic in the District of Columbia Superior Court.[18]
While acupuncture may not be a physiological cure for drug addiction, Dr. Carter told NewsBriefs it does have a soothing, relaxing effect which is extremely helpful to people experiencing any kind of lifestyle change, especially a change of the magnitude of drug withdrawal. However, to truly beat drug addiction, according to Dr. Carter, individuals need to learn to make decisions based on their own sense of self-worth and a confidence that they can change their environment.[19] Many practitioners like Dr. Carter feel that acupuncture is beneficial for addicts seeking this kind of change, even if too few controlled studies have been conducted to confirm that belief.
The Lincoln Clinic in New York City is the premiere detoxification center utilizing acupuncture in the U.S. Its director, Dr. Michael Smith, says the need for effective substance abuse treatment in the clinic's neighborhood is evident:
The South Bronx is a racially marginalized, high poverty, high unemployment, high crime, high infant mortality, low literacy neighborhood devastated by several decades of substance abuse.[20]
When the doctors at the Lincoln Clinic read in 1974 that a neurosurgeon in Hong Kong, Dr. H.L. Wen, had noticed a reduction in the withdrawal symptoms of opiate-addicted patients to whom he had been giving acupuncture treatments, they decided to experiment with the procedure at what had been until then a methadone clinic.[21] Over the years they developed a protocol that they have taught to more than 500 clinicians in 150 different programs.[22]
The Lincoln Clinic protocol relies on four major tools in helping serious addicts recover: acupuncture detoxification, urine testing, individual counseling, and participation in 12-step group-based therapy.[23] Smith argues that the advantages of integrating acupuncture into more traditional treatment programs are overwhelming. The primary value of acupuncture, however, is that its immediate effect is often a cessation of withdrawal symptoms, encouraging patients to come again for treatment in the future.[24]
Smith cites a few remarkable statistics to support the effectiveness of the Lincoln Clinic method. Among pregnant women with a history of abusing crack cocaine, those who receive acupuncture have higher birth weight babies than those who do not receive the treatment. Mothers with more than 10 visits have babies with an average weight of 6lbs. 10oz, while those with less than 10 visits have babies weighing an average of 4lbs. 8oz.[25] A seven-day inpatient drug treatment program in Delaware using the Lincoln Clinic method reported a decline in rates of recidivism from 87% to 18% one year after the date of admission.[26]
Dr. Smith attributes this effectiveness to a number of factors. One of acupuncture's greatest strengths, he argues, is that it forges a bond between doctor and patient even before verbal communication is established: "acupuncture will be just as effective even when the patient lies to us."[27] Unlike verbal counseling, during which the patient may be in denial or feel angry or intimidated, acupuncture's immediate effects are not dependent on the cooperation of the patient.
As stated previously, acupuncture's primary effect is to stimulate relaxation. "In addition to reducing withdrawal symptoms acupuncture provides a strong calming effect on substance abusers and substantially reduces drug craving. Clients describe the effects of acupuncture as allowing them to feel relaxed yet alert," according to Dr. Smith.[28] That feeling of relaxation is the essential benefit of the acupuncture protocol. Unlike methadone treatment, acupuncture affects the patient's state of mind during withdrawal, not the body's need for a drug.
The reputed success of the Lincoln Clinic made an impact on Chief Judge Gerald Weatherington and Judge Herbert Klein of the Eleventh Judicial Circuit of Florida, founders of the country's first drug court in Dade County, Florida.
Weatherington and Klein recognized that their problems with overcrowded jails and high recidivism among drug offenders were not being solved by the judicial system as it then operated. The Dade County Drug Court, which accepted its first arrestees in 1989, allows people facing charges of buying or possessing drugs the opportunity to submit to intensive addiction treatment.[29]
Uncooperative arrestees are often persuaded by the threat of incarceration to undergo the outpatient treatment, even if that treatment includes something as unusual as acupuncture. The primary incentive to comply with the program is that successful graduates have their charges dropped.[30]
Statistics on drug court effectiveness from Dade County's program and others around the country are, like the studies designed to measure acupuncture's efficacy, promising but not conclusive. The rearrest rates in the year following release were 60 percent for people who served jail or prison sentences and 11 percent for graduates of drug court.[31] In a review of Dade County's program, however, the National Institute of Justice found that one of the major stumbling blocks in this approach to dealing with the drug problem is that treatment providers have very different expectations from those of the criminal justice system.[32] People who work daily to help rehabilitate serious addicts understand that it is a difficult process, and a relapse is not a total failure. The criminal justice system, seeing relapse as the equivalent to criminal recidivism, is much less tolerant in this regard. It is difficult to gauge the true effectiveness of a drug court, therefore, because criminal justice and treatment agencies have different concepts of success.
Though the effectiveness of drug courts is open to debate, programs that incorporate acupuncture into their outpatient treatments are almost certainly less expensive than traditional methods of punishment. Federal estimates project that drug treatment programs cost an average of $1,200 per person, substantially lower than the $20,000 it takes to keep a drug offender incarcerated for one year.[33]
While acupuncture is only one component of Drug Court in Dade County or the District of Columbia, administrators have a strong conviction that it is an important part of treatment. In the early part of the program, acupuncture is used to help the patient through detoxification. Later, acupuncture treatments are phased out as the patient stabilizes. In aftercare, acupuncture is seldom used. Instead, the program seeks to build a strong sense of self-reliance with literacy education, GED courses, and vocational training. [34]
The evidence supporting acupuncture's effectiveness in detoxification treatment is largely anecdotal, and despite its use in some clinics and drug court programs, acupuncture is still considered an alternative medicine. In the 1970s, the Food and Drug Administration (FDA) ruled that acupuncture needles should be classified as "experimental" medical devices. That classification was a blow to the acupuncture industry since insurance companies, Medicare, Medicaid are reluctant to make payments for experimental treatments. A small group of the nation's leading acupuncturists petitioned the FDA in November 1994 to review its ruling. They are waiting for the FDA to decide.[35]
In the meantime, acupuncture continues to attract attention. One acupuncture convert is former United States Senator Dennis DeConcini. In 1994 he addressed the Senate with glowing praise of Dr. Xiao Ming Tian, the acupuncturist who treated DeConcini's neck pain. "His treatments relieved my pain and I do not hesitate to join other patients who have experience significant improvements under his care to pay tribute to him," DeConcini said.[36] Dr. Ming is the only practitioner employed by the federal government with a mandate to further explore the uses of acupuncture.
An important development in the field of acupuncture is a new study by Dr. Herbert Kleber of Columbia University's Center on Addiction and Substance Abuse. He is currently coordinating funding, including grants from the Hilton Foundation and NIDA, to do a large-scale, multi-site study of acupuncture's efficacy in treating drug addiction.
This comprehensive study will provide valuable information about acupuncture's usefulness in drug treatment. Regardless of the findings, however, more research on acupuncture and other forms of alternative medicine is needed and may reveal other secrets that Western medicine has yet to discover. Perhaps doctors in the United States will soon explain how 250 people experience the benefits of acupuncture at the Lincoln Clinic every day.