Acupuncture & Auriculotherapy:
Valuable Natural Treatment
Modalities for Addiction

Jay M. Holder, D.C., C.Ad. ♦ Carolyn Reuben L.AC. ♦ Tamia R. Sisco, D.C., Dpl. Ac. ♦ David K. Miller, M.A., CSAC II ♦ Kenneth Blum Ph.D., C. Ad.

Valuable Natural Treatment

In the last few years acupuncture and now auricular therapy have been used increasingly to treat substance use disorders. Studies of these modalities have validated their use, and more studies are needed and in process. Perhaps most important to the future are the growing acceptance of this treatment and the willingness of both Drug Courts and managed care organizations to provide it via licensed practitioners for use with multiple addictions.

While the mechanisms of acupuncture are not fully understood, modern research has demonstrated that successful acupuncture treatment results in a numbed of changes in important body proteins that could, themselves, act to decrease physical symptoms. These include indications that acupuncture mobilizes the opioid peptides (i.e. enkephlins, endorphins, dynorphins) or increase levels of other peptides such as substance P and cholecystokinin (CCK) among many others. There are also indications that acupuncture may induce alterations in certain hormones including Cortical and ACTH to reduce stress.

Since scientific research has shown that addiction, withdrawal, and recovery are all related to brain chemicals such as the opioid peptides and to stress regulating hormones in the body, it is reasonable, then, that use of procedures that effect these systems be explored. Some may be reluctant to trust the effectiveness and safety of acupuncture and auriculotherapy. However, the U.S. Food & Drug Administration (FDA) has recognized electrical devices used in auriculotherapy and the acupuncture needle as a medical devices. Research support for the effectiveness of the procedures is abundant and will be discussed later.

While there are some who claim that there are not enough sound clinical studies to support efficacy of acupuncture, ear acupuncture or auriculotherapy, others would support its use. It is our contention that, in light of the positive studies, it would be unwise to dismiss its use as being worthless and that many more controlled studies are warranted.

AURICULOTHERAPY

ACUPUNTURE

Acupuncture dates back thousands of years. Specifically, acupuncture is 6000 years old and ear acupuncture is 2,500 years old. In essence, traditional Chinese healers seek to restore a dynamic balance between two complementary forces that pervade the human body and travel through meridians as CHI (life energy). Acupuncture corrects the excess or the deficiency of CHI along meridians. Acupuncture involves stimulation of certain points on the skin, mostly with ultra fine needles that are manipulated manually or electrically.

Today, acupuncture is international; its practitioners include professional acupuncturists and a variety of other health care providers including medical doctors. Upward of 2,000 acupuncture points are now recognized by licensed acupuncturists. By 1982 there was a sufficient number of acupuncture schools to warrant the development of the National Council of Acupuncture Schools and Colleges, which evolved into the Accreditation Commission for Acupuncture and Oriental Medicine or ACAOM. Today 32 programs are within ACOM's purview.

Most states permit licensed physicians to perform acupuncture as part of their medical practice, but this may vary from state to state. Most states provide for the practice of acupuncture by chiropractors on the basis of additional 100200 hours of training. Many states have adopted legislation to permit the practice of acupuncture by individuals who are not medical doctors chiropractors such as doctors of naturopathy, podiatrists, physical therapists, physician's assistants, nurses and counselors, but training requirements vary.

EAR ACUPUNCTURE IN THE TREATMENT OF SUBSTANCE USE DISORDERS

As stated earlier, acupuncture has been around for thousands of years. In more recent times Hsiang Lai Wen of Hong Kong successfully applied electrical stimulation to one point in the ear to relieve opiate withdrawal symptoms. Inspired by this work, Michael Smith, an American physician, first used the Wen protocol as part of a methadone program at Lincoln hospital in Bronx, New York. Over several years, Smith and coworkers refined the detox protocol into five ear points that are needled without electrical stimulation. To promote his protocol, Smith founded the National Acupuncture Detoxification Association (NADA), and for the past 25 years he has championed the use of acupuncture detox in a wide variety of clinical settings including county jails, maximumsecurity prisons, outpatient drug treatment programs, homeless shelters, and mental health facilities.

At about the same time, HaightAshbury Free Clinic (HAFC) in San Francisco began to utilize acupuncture for the treatment of addiction. In fact, one of us (KB) published a paper with others at the HAFC on the favorable outcome of utilizing ear acupuncture in alcoholic withdrawal.

AURICULOTHERAPY

The original work of Paul Nogier, M.D. of Lyon, France in 1956 provided the world with what is now called auriculotherapy. A common misconception is that auriculotherapy is ear acupuncture. While ear acupuncture depends on the use of needles inserted among a fixed set of alleged acupuncture points, auriculotherapy does not involve fixed points and does not use needles. Auriculotherapy points are created by enervation of four cranial nerves and three cervical ganglia. These are not acupuncture points. The professional uses a handheld STIM PLUS PRO (an FDA class 11 medical device) shaped like a pen to (1) locate the auriculotherapy point, (2) diagnose the located auriculotherapy point, and (3) treat the auriculotherapy point if measured to be abnormal.

Auriculotherapy is defined as the location and treatment of neurological points in the ear by micro-current stimulation. Each point is treated by the handheld pen-shaped device (described above) for 30 seconds. The procedure is painless. Both ears are treated five days a week for 1530 days for 10 minutes. In ear acupuncture, needles must be left in place for 45 minutes to 1 1/2 hours.

DRUG COURT AND ACUPUNTURE

RESEARCH SUPPORT FOR ACUPUNCTURE & AURICULOTHERAPY

Since the late 1970's and the 1980's numerous studies have been performed in order to evaluate acupuncture and recently auriculotherapy in the treatment of addictive behaviors. A recent MEDLINE search found over 9,780 studies dealing with the use of acupuncture (in all forms) for SUD including alcoholism, heroin addiction, stimulant abuse, binge eating and smoking behavior. The majority of data come from the most obvious application of acupuncture: the attempt to decrease the pain and other discomforts associated with opiate addiction. A number of positive studies by Wen in 1977 showed intense relief of withdrawal symptoms within 15 minutes of the beginning of the procedures. A subsequent one year follow up of the sample by Schuckit and associates revealed that 51 had been free of drugs during the interval. In 1985, Kroening and Oieson found that the combination of precipitous opiate withdrawal along with auriculotherapy was successful, with 86% of the patients withdrawing within five to seven days with a minimum of side effects. Currently the literature reveals a number of positive studies using acupuncture, ear acupuncture, or auriculotherapy including: smoking (He et al. 1997), alcoholism (Brewer 1995); cocaine addiction a five point approved and established protocol as defined by the National Acupuncture Detoxification Association (NADA).

5. Patient Comments include a number of very positive responses. In this regard here are a few to consider: "A change in attitude." "Moods are less erratic." "Feeling good from within." "Full of energy." "Headache is gone." "Now actually sleeping." "This was the quickest I kicked heroin." "It reduces my craving for booze, and it brought back my natural energy." "I feel less stress." "I'm calmer." "Before acupuncture, even though I was clean I never once stopped craving drugs. Since acupuncture, I've stopped the craving."

6. Counselors of drug court had this to say: "Patients are coming in more balanced emotionally, mentally and physically." "I have seen tremendous results with acupuncture for my patients."

DRUG COURT AND ACUPUNCTURE

The Drug Court is one of the most famous programs to incorporate the use of acupuncture detox treatment. Janet Reno, the former Attorney General, was one of the founders of the original Drug Court in Dade County, Florida in 1989. Over the past decade, Drug Court programs have switched the criminal justice approach to drug abuse from one based in punishment to one rooted in rehabilitation.

In general, if drug offenders, including DUI offenders, decide to participate in a typical one year Drug Court program, their arrest will be erased from their record and they will be released from probation. One of us (CR) is the licensed acupuncturist for the Sacramento based Drug Court. In this program, along with drug testing and counseling, clients receive auricular acupuncture five days a week.

Some programs encourage other important modalities. The Canadian scientist, Bruce Pomeranz, found that the amino acid Dphenylalanine has been shown to potentiate the analgesic effects of acupuncture in rodents. With this in mind, two of us (KB & CR) are engaged in a scientific study to assess the result of combining amino acid therapy (using the REWARD"" System developed by KB) and acupuncture to treat clients in a Drug Court setting. It is noteworthy that since the nutritional supplement component of Sacramento's Drug court began in July 1998, the percentage of program graduates has risen by 39 percent. Moreover, work by TRS, KB & DKM is proceeding with DUI offenders at the Excel Treatment Program in Denver Colorado in conjunction with the Denver Drug Court System. In this program, the combination of counseling, acupuncture, and amino acid therapy (both oral & intravenous) has produced significant positive results in preventing relapse.

SAFETY CONCERNS AND ORGANIZATIONS

SAFETY CONCERNS

Clearly, potential for serious harm anytime the human body is penetrated with a sharp instrument is one of concern. However, a sterilized acupuncture needle in the hands of a properly trained professional will rarely do substantial damage. Probably the two most common adverse effects of acupuncture are slight bruising at the site of needle insertion and transient sensations of numbness and tingling. Infection from inadequately sterilized or improperly handled needle is a more serious complication. Most states that have adopted the NCCAOM examination, which also require acupuncturists to pass a separate course on the principles of infection control and the proper handling of equipment. A few isolated cases of the hepatitis B virus via acupuncture needles have been reported. Apart from one unverified report originating in Europe, there have been no cases of the transmission of HIV infection through acupuncture.

SUMMARY

Acupuncture is especially attractive because it does not involve long term administration of medications. There is a potential for future studies using either acupuncture or auricular therapy, especially in the field of stimulant withdrawal. Finally, all published reports to date suggest that acupuncture (in all forms) is likely to be of optimal use when combined with additional treatments such as amino acid therapy (both oral and intravenous), psychotherapy, counseling, education, outreach to the family, and appropriate self help groups. There are 1200 treatment programs in the US and abroad using acupuncture, and the number of drug treatment programs incorporating acupuncture is growing each year. Recovery from addiction is difficult and subject to relapse. People in recovery need more tools like acupuncture and auriculotherapy to improve the quality of recovery as well as to reduce the risk of relapse.

BOOKS & REFERENCES

Kaptchuk, T. The Web That Has No Weaver. New York, Congdon & Wood. 1983. A comprehensive explanation of the clinical world of Chinese Medicine. Micozzi, M. ed. Fundamentals of Complementary Unschuld, P. Medicine In China. A History of Ideas. Berkeley University Of California Press. 1985. An outstanding history of the practice of Chinese medicine. Blum. K . et al. Journal Of Psychoactive Drugs. Reward deficiency Syndrome: A Biogenetic Model For The Diagnosis and treatment of Impulsive, Addictive & Compulsive Behaviors. 32: November Supplement 2000. San Francisco. A detailed article involving treatment and genetics of Addiction Medicine. Oleson, T., The Auriculotherapy Manual, 2"d edition, UCLA, 1998. Durijan, M. Ruben A., An Introduction to the physiology of Auricular Reflex Thearpy :International Meeting Of Acupuncture and Auriculomedicine, Madrid, Spain, 1980. United States Senate Subcommittee Minutes on Janet Reno/Jay Holder: Research on Ear Acupuncture and Auriculotherapy in Addiction Treatment, 103rd Congress, 1St session, Page 64, U.S. Government Printing Office, Washington, 1993. Holder, J., Smith, M. State of the Art treatment: Acupuncture, National Consortium of TASC Programs (NCPT), 3`d National Conference on Drugs and Crime Bulletin, Austin, Texas, 1993. Nogier, P. Treatise of Auriculotherapy, Maisonneuve, France, 1972 (see Blum et al. J.Psychoactive Drugs). Blum,K., Cull, J., Braverman, E., Comings, D. Reward Deficiency Syndrome. American Scientist: 84 : 132=45,1996. Avants,G., MargolinA., Holford, T., Kosten,T. A randomized controlled trial of auricular acupuncture for cocaine dependence. Archives of Intemal Medicine 160: 230512, 2000.

ORGANIZATIONS

• American Association Of Oriental Medicine (AAOM)
  433 Front St.
  Catasauqua PA 18032
  610-266-1433
• American Academy of Medical Acupuncture (AAMA)
  5820 Wilshire Blvd suite 500
  Los Angeles CA 90036
  213-937-5514
• Accreditation Commission For Acupuncture & Oriental Medicine (ACAOM)
  1010 Wayne Ave.
  Suite 1270
  Silver Spring Md. 20910
  301-608-9680