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The Successful Use of Auricular Acupuncture in the
Supported Withdrawal and Detoxification of Substance
Abusers
By
Simon Fidler
This is an edited version of an interesting and extensive report/study
of the use of acupuncture in drug addiction. Copies of the full report
can be obtained buy contacting the address at the end of this document.
Acupuncture has become widely available from private practitioners in
the UK in recent years. Its significant rise in availability and
popularity has coincided with increased interest in a number of so
called 'complementary therapies' which mainly emanate from the Far East.
Acupuncture is commonly considered by Western medical practitioners to
have little more credibility than many other 'complementary therapies'
and is often dismissed by them along with 'alternative' treatments with
little or no history or proven efficacy. However, the rapid increase in
acupuncture practitioners in the UK and the relatively high cost of this
particular 'complementary therapy' suggests many people are convinced it
should not be so readily dismissed as just another trendy and unproved
form of medicine.
One of these community based services, The Gateway Clinic, is within the
National Health Service and provides treatment on a drop-in basis five
days a week. A wide variety of stress related conditions are addressed
by the "formula" type of detoxification acupuncture provided at this
Clinic (see Appendix 6.4) which is part of the West Lambeth Community
Care Trust. The cost of treating an individual in this way, five times a
week and with reusable needles, is only 50 pence (35 cents) per week. In
addition to this stress-management acupuncture this Service also offers
Chinese Herbal medicine and full body acupuncture to those considered in
need of these treatments.
Acupuncture is an extremely old Chinese mode of treatment now practised
all across the globe. It focuses on restricting the flow of energy in
the body. By applying extremely thin needles at set places in the body,
the equilibrium is restored. In 1972 Dr. H.L. Wen, a Hong Kong
neurosurgeon, accidentally discovered the usefulness of acupuncture in
treating drug addiction. He was treating a patient for a concussion. The
patient was also known as an opium addict and Dr. Wen proposed a
cingulutomy as treatment for the addiction. A cingulutomy is a
prefrontal lobotomy that severs certain functions between the two
frontal hemispheres. The patient was anaesthetised using acupuncture.
Even before the operation began, the withdrawal symptoms were reduced
and even disappeared altogether. The operation was cancelled. Every time
the withdrawal symptoms occurred again, the patient was treated with
acupuncture until they stopped occurring at all.
In Europe and America, acupuncture has been used since the early 70s in
clinical and outpatient treatment programmes for alcohol and drug
addiction. The role of acupuncture is a modest one and has not really
developed much further than in Dr. Wen's practice in Hong Kong, i.e. to
help patients during the withdrawal stage. Heroin addicts who come to a
clinic for detoxification can chose between switching to methadone or
stopping altogether with acupuncture. If they opt for acupuncture, then
twice a day for three days and once a day for the next three days, thin
needles are inserted in five spots in their ear and one spot on their
hand, between the thumb and index finger. The points on the ear have
their reflex to different bodily functions or organs. The effect of
these different points is that they make people feel more relaxed,
alleviate
Anxiety and uneasiness and reduce perspiration, intestinal
cramps, watery eyes and sneezing. The excretion of toxic substances is
reinforced, so the patient feels better faster.
There are no substitutes for cocaine and hashish addicts to help them
stop using drugs. Acupuncture is the only alternative and most people
accept it, since they feel that even if it doesn't do any good, it still
can't hurt. The treatment of hashish and cocaine addicts with
acupuncture is mainly focused on re-establishing an emotional
equilibrium.
Although many people are sceptical about acupuncture, in general cocaine
addicts turn out to be quite satisfied with it. The results with hashish
addicts have been less positive. After they stopped smoking hashish,
traces of THC, the active ingredient in hashish, remain in their urine
for weeks, whereas within three days, the urine of cocaine users is
clean. A heavy hashish smoker is apt to exhibit such symptoms as
restlessness, depression and craving for quite some time. Experience has
shown that this category of addicts often prematurely drop out of the
clinical as well as the outpatient treatment programmes.
Acupuncture is effective in reducing mood changes, irritability,
insomnia and fatigue.
Auricular acupuncture has successfully been used within the county of
Hampshire by the Winchester drug problem team, Highclere detoxification
centre and Face to Face Dasein. All practitioners were fully trained and
in some cases electro stimulation was used over a period of five years.
e.g. Face to Face Dasein. Other treatments are also used to compliment
the acupuncture.
Moxibustion involves stimulating acupuncture points with heat. It
introduces energy into the body either by heating the needle or the skin
with a moxa stick or by burning moxa directly on the skin (moxa is the
dried leaves of the Herb artemisia vulgaris latiflora).
Electrostimulation enhances the effect of the needles and can be used to
either stimulate or sedate. Different frequencies produce different
physiological responses in the body. (Transcutaneous Electrical Nerve
Stimulation) machines can be useful in treating
Anxiety and pain.
Other treatments supplied and/or advice provided:
- Herbal teas - detoxification or sleep
- Relaxation techniques
- Dietary advice - usually high C protein
- Bach flower remedies
- Vitamin supplements
A clients perspective
"Acupuncture has, without a shadow of a doubt helped in a great way to
correct those issues, bringing back the balance in the body which has
been out for so long. My personal view of myself now is completely
different being more assertive, confident, less anxious, determined to
do something positive with one's life. When I detoxified before I
remained clean for 7/8 weeks and through that time I was timid, shy as
well, thoughts of what was the point of carrying on all solved with one
hit or dose. The other thing I find with seeing my acupuncturist is I
see her as my therapist as well. Every time I have treatment we
initially spend 5/10 minutes on talking about how I am, any problems,
cravings, which after my 2 3rd session have subsided to nothing, care of
addiction/endorphin points in acupuncture."
In 1973 Wen and Teo reported that a new approach to relieving the drug
withdrawal syndrome and counteracting drug addiction itself, had been
used in the Tung Wah and Kwong Wah Hospital in Hong Kong - 'By means of
acupuncture with electrical stimulation, a form of treatment which had
not been attempted before. By November, 1972, 40 drug addicts had been
treated by acupuncture with electrical stimulation. The technique used
involved needling the patients' ears on each side, subcutaneously for
half a centimetre in the middle of the cavum conchae. The acupuncture
point used is the 'lung' point on the ear. After cleansing the ear with
an alcohol sponge, a sterile acupuncture needle is inserted and the
needle connected to an electrical stimulator. The frequency of the
current is gradually increased from 0 to 125 hertz. The intensity is
increased until the patient feels the flow of current but without
causing pain. The length of treatment varies in each individual but on
average lasted for half an hour.
Within ten to 15 minutes the patient confirmed that the eyes, nose and
mouth were dry; aching, shivering and abdominal pain were gradually
disappearing; the breathing became more regular; the patient felt warm
and relaxed. Of the 40 cases, 39 were discharged free of drug addiction.
Within four months eight returned to have one or two repetitions of the
treatment.
It was the comparison of these two groups which concerned this study.
The results were the electro-acupuncture group detoxified on average for
eight days, compared with the methadone group's average of 14 days.
After one year's observation, it was found that 51.42% of those treated
with electro-acupuncture were still drug free, while the in the
methadone group on 28.57% were still drug free.
At the Lincoln Hospital, it took more than a year to build up a
generally positive reputation for acupuncture among the drug addicts
treated there. By 1975 many considered trying acupuncture but the habit
of relying on narcotics led them to favour methadone detoxification
instead. Approximately ten to 15 patients a month chose to detoxify from
heroin addiction exclusively by means of acupuncture.
The Lincoln Detox Programme (USA) observed that the use of acupuncture
points located in the external part of the ear gave the best results in
the treatment of the opiate dependent addict. Hence, the current method
adopted involving needling of the following points - 'sympathetic',
'shenmen', 'kidney', 'liver' and 'lung'.
The method the Lincoln Detox Programme used was acupuncture treatments
usually given once a day to each patient. Careful selection of the
acupuncture points was considered as the most important aspect of the
treatments. Usually each day different points needed to be stimulated
for the treatment sessions to be successful.
In 1985 research at the University of Minnesota and the Downstate
Medical Centre in the United States confirmed that acupuncture
substantially reduced withdrawal symptoms and the craving for drugs. A
subsequent study at the Lincoln Hospital in 1988 provided further
evidence of the successful use of acupuncture for the treatment of
opiate dependency. Smith and Khan reported that it was the primary
method of treatment for drug addiction and claimed the importance of the
following functions of acupuncture:
- relief of withdrawal symptoms
- general relaxation and homostatis
- apparent enhancement of mental and physical functioning through activating the reserve capabilities of the body
Because the ear is not considered a separate organ but closely connected
to channels and zang-fu organs, it is part of the body as an organic
whole. It is possible that reactions can be detected at the
corresponding areas of the auricle. Further, disorders from various
parts of the body, including withdrawal symptoms, can be cured by
needling the corresponding auricular points.
It has been demonstrated that acupuncture stimulates the production of
endorphins. . The lengthy use of opiates reduces the production of
endorphins, so that as soon as the drug use stops, there is a
deficiency. Acupuncture can also greatly reduce the drop out rate among
alcoholics. In cocaine addicts, acupuncture appears to have a
particularly strong affect on the craving.
Of the three sub-groups involved in the trial at Winchester, the
benzodiazepine group appeared to respond most positively, followed by
the long term methadone clients and then the heroin users. All the
benzodiazepine clients had been on this medication for a decade or more
and yet all achieved their objectives.
Of the methadone clients who did complete both the acupuncture treatment
and detoxification process 30% have since relapsed. At the time of
writing 50% of the clients that detoxified from methadone are believed
to still be free of opiates.
All clients felt their acupuncturist had assessed their needs highly
accurately. All stated they would recommend acupuncture to others and
particularly to those detoxifying from dependency forming drugs. And 75%
those starting courses of acupuncture, completed them. The usual drop
out rate from residential detoxification programmes is nearer 50% during
the first ten days of treatment.
Most of the medical doctors that work in partnership with the Team are
now prepared to prescribe Lofexidine (Britlofix) to those detoxifying
from opiates, despite the relatively high cost of this medication;
approximately £80 ($120) for the two week course. Some are also prepared
to prescribe naltraxone, the opiate antagonist, to those wishing to stay
drug free with the assistance of this medication; costing approximately
£40 ($60) a month for three to six months.
I should like to express thanks to clients and colleagues. But a sad
note: The Social Services budget was financing the purchase of
acupuncture. However, the Social Services Department subsequently agreed
with the North and Mid Hampshire County Health Commission that the
purchasing of acupuncture fell within their remit; as it is a bodily
invasive therapy and commonly regarded as 'complementary' to other
medical treatments. It is unfortunate that this defining of
responsibility for the purchasing of acupuncture has occurred while the
Health Commission is in a financial crisis and unable, therefore, to
consider any new treatment expenditure whatsoever. As a consequence, the
vast majority of clients have been unable to receive acupuncture whilst
detoxifying or trying to remain drug free. We are currently exploring
possible alternative sources of funding to enable us to continue
providing this evidently effective and highly valued treatment.
Simon Fidler
Community Drug Advisory Service,
St. Pauls Hospital
Winchester,
Hampshire,
SO22 5AA
England
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