The use of acupuncture for the treatment of drug and alcohol dependency (Acudetox) is a recent development in the history of Traditional Chinese Medicine.
The History of Ear Acupuncture
For centuries, the Chinese have placed needles in precise locations on the body to relieve pain and treat disease. Since 1972, when a Hong Kong neurosurgeon, H.L Wen M.D., discovered that acupuncture could alleviate the symptoms of drug withdrawal, has this method been used for detoxification and relapse prevention.
In the USA, Acudetox was first introduced on an outpatient basis in 1974 at the Lincoln Memorial Hospital, a city facility in the South Bronx area of New York City. By the mid 1980's the success of this unique procedure had become so evident that alcohol and drug treatment facilities across the USA began incorporating acupuncture into their treatment programmes.
In 1985, the National Acupuncture Detoxification Association (NADA) was established to promote education and training of clinicians in the use of Acudetox through the NADA five-point ear acupuncture protocol. NADA is a non-profit association that conducts training and provides public education about the use of acupuncture as an adjunctive treatment for both addictions and mental illness disorders.
In 1987, Bullock, Culliton and Olander first published research on its effectiveness of auricular acupuncture in treating people with chronic drug dependency problems. 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.[1]
Due to the lack of effective treatment for drug addiction, auricular acupuncture is used to treat this disorder in numerous drug and alcohol rehabilitation centres. A study designed to evaluate the effectiveness of auricular acupuncture for the treatment of cocaine addiction looked at eighty-two cocaine-dependent, methadone-maintained patients. Patients were randomly assigned to 1 of 3 conditions: auricular acupuncture, sham acupuncture, or a no-needle relaxation control. Treatment sessions were provided 5 times weekly for 8 weeks. The primary outcome was cocaine use assessed by 3-times-weekly urine toxicology screens. Results showed that a longitudinal analysis of the urine data for the intent-to-treat sample showed that patients assigned to acupuncture were significantly more likely to provide cocaine-negative urine samples relative to both the relaxation control and the sham acupuncture. Findings from the current study suggest that acupuncture shows promise for the treatment of cocaine dependence.[2]
Another study tested the viability of auricular acupuncture in prisons for alleviating inmates' symptoms of psychological and physical discomfort and reducing their drug use. The experimental NADA-Acudetox protocol was compared with a non-specific helix control protocol in a randomised trial. Over a period of 18 months, a 4-week, 14-session auricular acupuncture treatment program was offered in two prisons to 163 men and women with self-reported drug use. Among those who completed treatment, no differences in self-reported symptoms of discomfort were found. Interestingly, drug use occurred in the NADA group but not in the helix group. In contrast, however, confidence in the NADA treatment increased over time while it decreased for the helix treatment. No significant negative side effects were observed for either method. Participants in both groups reported reduced symptoms of discomfort and improved sleep. Future research should compare auricular acupuncture to a non-invasive control in order to attempt to disentangle active effects from placebo.[3]
Acupuncture has been proven to be successful in both clinical settings and under controlled experimental conditions. The results obtained from a one year acupuncture detoxification program study in Portland, Oregon and a blind study of acupuncture treatment with chronic alcoholics in Hennepin County, Minnesota were as follows;
People who received acupuncture detoxification treatment were two times more likely to continue in rehabilitation therapy than people who did not receive acupuncture treatment. More than 70% of people treated with acupuncture successfully completed detoxification, compared with only 50% of those who did not receive the treatment. For those detoxifying from alcohol, the success rate was 90%. Recidivism of alcohol and drug addicts decreased from 20-25% to 5% for patients receiving acupuncture detoxification treatments.[4]
A pilot study was conducted by the City of San Diego to determine whether or not acupuncture was helpful in curbing the drug addictions of parolee patients with treatment and/or motivated these parolees to search for a higher quality of life without drugs. The hope was to find if acupuncture would ease the patients through the initial stages of Post Acute Withdrawal Syndrome (the emotional, psychological, and physical symptoms of ridding the body of the substance) and to keep them in treatment longer. The Solutions program began acupuncture treatments on September 1, 1993 and the results are as follows;
The research procedures included the case tracking of 52 acupuncture clients and a comparison group of 64 individuals in treatment without acupuncture. Study results indicate that acupuncture may have an influence on the length of time in treatment and reduce or eliminate drug use. Acupuncture clients stayed in treatment nearly twice as long as the comparison group (an average of 93 days for the acupuncture clients compared to an average of 48 days for the comparison group.) In addition, the acupuncture clients received more individual counselling, support services, and employment referrals than the comparison clients. The average number of acupuncture treatments received per client was ten. The average time spent in the program for successful acupuncture clients was almost double the average time for successful comparison clients (113 days versus 70 days, respectively).
90 percent of the acupuncture clients, compared to 69 percent of the comparison group, reported no drug use since the beginning of the treatment program. 33 percent of the acupuncture clients were employed in the beginning of treatment, and by the end of treatment, 65 percent were employed. While the comparison group also show an increase in employment upon program completion, the total number of comparison clients employed upon exit was less (43 percent).[5]
In Ireland these NADA points have gained popularity already in a Drug Rehabilitation Centre in Tallaght. Community-based workers consisting of six men and 2 women in Fettercairn Drug Rehabilitation Centre and other family-support services in Tallaght, were studying to become ear-acupuncture detox specialists. They were following a protocol set in 1985 by the National Acupuncture Detoxification Association (NADA), an American organisation. The model has proved successful around the world in easing withdrawal symptoms from heroin, methadone, alcohol and codeine.[6]
Not all results have proved conclusive however. There has also been shown to be a non-statistical difference between the real and sham acupuncture. This study tested the viability of auricular acupuncture in prisons for alleviating inmates' symptoms of psychological and physical discomfort and reducing their drug use. The experimental NADA-Acudetox protocol was compared with a non-specific helix control protocol in a randomised trial. Over a period of 18 months, a 4-week, 14-session auricular acupuncture treatment program was offered in two prisons to 163 men and women with self-reported drug use. Among treatment completers, no differences by method were found in self-reported symptoms of discomfort. Drug use occurred in the NADA group but not in the helix group. In contrast, confidence in the NADA treatment increased over time while it decreased for the helix treatment. No significant negative side effects were observed for either method. Participants in both groups reported reduced symptoms of discomfort and improved night time sleep. Future research should compare auricular acupuncture to a non-invasive control in order to attempt to disentangle active effects from placebo.[7]
From a Traditional Chinese Medicine perspective this may be explained as even stimulation as points that are not traditional points may still exert an effect as all points are connected by tiny divergent meridians called the sun lou and fen lou. In recent years the retractable type of sham needle has been anticipated to be a possible solution for masking patients in acupuncture research. However, this needle has been intended mainly for acupuncture-naïve subjects. The difficulty of finding a suitable control still remains.
The NADA protocol consists of the insertion of five, small, fine, sterile stainless steel needles under the surface of the skin on specific sites in the outer ear. No electrical stimulation is used. The recipients sit quietly in a group setting for up to 45 minutes, relaxing. These five points are standard points for the treatment of substance misuse and anxiety management. The NADA protocol is most effective when used in combination with other treatment modalities. The combination of acupuncture with counselling and self-help / support groups, etc. enhances treatment effectiveness. Acupuncture treatment for substance misuse has shown to be clinically effective, cost efficient, drug free and compatible across cultures. A clinic can be established with minimal difficulty within most settings.
Currently, over one thousand treatment programmes in the USA now use acupuncture and NADA US has trained over 5000 clinicians in the USA and worldwide. Many European countries now utilise the NADA protocol and have their own national independent NADA Associations and hold annual national conferences on a yearly basis.[8]
The NADA protocol has been shown to decrease significantly:
- Craving for alcohol and drugs withdrawal symptoms
- Relapse
- Inpatient detoxification admissions
- Anxiety, insomnia and agitation
Clients are usually surprised to discover that daily acupuncture provides consistent relief of cravings and withdrawal symptoms.[9]
Auricular acupuncture has existed for three thousand years in China. However it has been found in many different societies throughout history. These societies include Ancient Egypt, Greece, India, Scythia. Interestingly the most popular uses were for treatment of sciatica by cauterisation or as a contraceptive tool.
The modern use of acupuncture was developed in the 1950's by a French Canadian called Nogier who took on board the prevailing ideas of reflexology of Eunice Bailey and sound therapy developed by Tamatis to develop a model of the ear based on an upside down foetus. The French Ear was an integrated model based on embryology and psychotherapeutic principles. The Chinese took the ideas of Nogier and developed a different model based on empirical studies done on the Red Army. This is the ear model that we use today.
Essential skills of Ear Acupuncturists
- Understand health and safety theory in and practice.
- Good point location especially the NADA ear points.
- Good needle technique.
- Good knowledge of Ear Anatomy.
- Demonstrate good practitioner skills - communication, boundaries, attitudes, client support.
- Good knowledge and use of ear magnets, press seeds, press needles.
- Good knowledge of crisis intervention e.g. fainting.
- Use of ear qi gong and massage as a therapeutic tool.
- Health and Safety Policy
- Use of patient consent forms Record client details
- Clients should go to the toilet before inserting needles.
- Needles should be removed if the patient needs to go to the toilet during the session.
- Patients should be still during the session unless using seeds only.
- Clear instructions should be given to the client about the procedure, particularly about informing you should the patient feel faint.
- Clean field should be set up.
- Count the needles in and out.
- Ensure that practitioner takes the needles out.
- Wash hands before performing acupuncture.
- Ask the patient to move their head rather than forcing it; similarly with removal of the hair from the face and ear.
- Use sterile needles.
- Remove one needle at a time touching only the handle.
- Follow needle insertion procedure.
- Make sure that the client does not put his hand into the sharps box for any reason.
- If there is any doubt in the mind of the patient refer to the practitioner.
- Use Accident Book if there is an event.
Ethical considerations
- Use ear acupuncture in a nurturing and supportive way.
- Never to withhold treatment as a punitive measure.
- Confidentiality of all records and knowledge concerning patient.
- To avoid claiming directly or otherwise professional qualifications or competencies that exceed those actually obtained.
- Not to denigrate other professional services.
- To provide accurate information on education, training, experience, professional affiliations and certification.
- Strive for professional competency through personal evaluation, additional training.
- To encourage the use of other services such as counselling especially in the case of addiction.
- Encourage positive intention.
- To act in accordance with the code of ethics and practice of the relevant register.
The Ear as a Diagnostic Tool
The ear itself can provide a great deal of information in assessing the health of the person. It involves using both visual and palpation skills. The size of the lobe indicates longevity. Ear lobe creases can indicate coronary problems..... or intolerance problems to other scientists. The colour of the ear will reflect the disharmony of the organs according to the correspondences of the five elements. However, if an ear is dark red, black or grey this indicates a chronic problem particularly in the kidneys, heart or blood circulation.
Using palpation with the thumb and index finger, the stiffness of the ear and any other irregularities will be indicated. Using a probe or palpator it is possible to find sensitive spots on the ear. Record these areas. The degree of sensitivity relates to the severity of condition; the more sensitive the point the more serious the problem. Tenderness appears within 12 hours after a health problem occurs. The area becomes more sensitive after a health problem occurs and disappears within seven days after the problem is corrected.
Treatment of the Ear
The ear can be treated using a whole variety of techniques - needles, press seeds, press magnets, press needles, moxabustion, massage and qi gong techniques. In addition there are other techniques that are outside the scope of this course such as sound therapy (TAMATIS THERAPY and others), Hopi Ear Candles, homeopathy and herbal medicine. These will all fall under the scope of Naturopathy. The emphasis on this course is ensuring that you are safe to practise.
Therefore there are four aspects which need to be considered:
1. Needle technique
2. Needle removal
3. Clean field issues
4. Contraindication
Needle Technique
Equipment: 7mm - 15 mm sterile disposable needles, sharps bin, cotton buds, cotton wool, mediswabs, (if applying press solutions afterwards)
1. Clean hands. Make sure client is comfortable with legs uncrossed. Clean client ears if necessary.
2. Stand beside the client. Open packet of sterile needles beside the client. Ask client to hold the needles.
3. Hold the ear lobe or helix with non needling hand. Ensure that the needle is being inserted at the same level as the ear, using horse stance or from sitting position.
4. The needle should be held against the ear point without physically touching the ear. Insert the needle with clockwise twist as the client breathes out (like a dart). Do not push the needle in but use your qi. If needle droops and is in danger of falling out repeat this step. If needle penetrates through the cartilage withdraw needle slightly. Work from the top of the ear downwards unless using difficult points like sympathetic.
5. Once inserted do not move around the room. Needles remain in for 35 mins or more.
Removal of Needles
1. Place sharps bin on the floor next to the client. Put a cotton bud in your hand behind your back.
2. Remove needles one at a time from the bottom up.
3. Place each needle separately in the bin.
4. Stop bleeding if it occurs with a cotton bud and place in sharps bin.
Health and Safety
- Involves setting up an environment that maximises hygiene and minimises infection risks;
- Wash hands before and after treatment.
- Put a clean field of couch roll on a clean prepared surface.
- All needles and sterile cotton wool are put on the couch roll on this surface.
- Sharps bin is put on the floor or outside the clean field.
Contraindications
1. Intoxicated with alcohol
2. High on drugs
3. Inflamed or broken skin on the ear
Cautions
- Pregnancy - kidney and shenmen only.
- Epilepsy - use only one point at a time and increase as tolerance allows.
- Haemophilia - with care and avoid sympathetic.
For further details contact Carina This email address is being protected from spambots. You need JavaScript enabled to view it..
Auriculartherapy Ear Acupuncture
[1] Bullock ML, Kiresuk TJ, Sherman RE, Lenz SK, Culliton PD, Boucher TA, Nolan CJ., Lancet. Controlled trial of acupuncture for severe recidivist alcoholism 1990 Jan 6;335(8680):20-1.
[2] Avants SK, Margolin A, Holford TR, Kosten TR., A randomized controlled trial of auricular acupuncture for cocaine dependence. Arch Intern Med. 2000 Aug 14-28;160(15):2305-12.
[3] Berman AH, Lundberg U, Krook AL, Gyllenhammar C., Treating drug using prison inmates with auricular acupuncture: a randomized controlled trial. J Subst Abuse Treat. 2004 Mar;26(2):95-102.
[4] An Acupuncture Based Drug & Alcohol Detoxification & Treatment Program, formally of Santa Monica, CA. http://www.acupuncture.com/research/detox.htm
[5] Jack Miller., Evaluation of an Acupuncture Program for Drug Treatment in San Diego County
[6] Starting to feel needled, The Irish Times, Monday, August 20, 2001
[7] Berman AH, Lundberg U, Krook AL, Gyllenhammar C. Treating drug using prison inmates with auricular acupuncture: a randomized controlled tria., J Subst Abuse Treat. 2004 Mar;26(2):95-102 [8] http://www.nadauk.com/html/history.htm
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