Acupuncture & auriculotherapy: valuable natural treatment modalities for addiction

Townsend Letter for Doctors and Patients, Dec, 2005 by Carolyn Reuben, Thomas J.H. Chen, Seth H. Blum, Eric Braverman, Roger Waite, Judith Miller, Steve Sewall, Kenneth Blum, Brian Meshkin, Julie Mengucci

A Commentary

In the last few years acupuncture and now auricular therapy have been used increasingly to treat substance use disorders (Unschuld, 1985). 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 number 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 cortisol and ACTH to reduce stress (Han & Shao, 1990).

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 affect these systems be explored. Some may be reluctant to trust the effectiveness and safety of aucupuncture and auriculotherapy. However, the US Food & Drug Administration (FDA) has recognized electrical devices used in auriculotherapy and the acupuncture needle as 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 (Micozzi, 1996).

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Acupuncture

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 (Kaptchuk, 1983).

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 an additional 100-200 hours of training. Many states have adopted legislation to permit the practice of acupuncture by individuals who are not medical doctors or 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 co-workers 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, maximum-security prisons, outpatient drug treatment programs, homeless shelters, and mental health facilities. At about the same time, Haight-Ashbury 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 (Blum et al., 1978).

Auriculotherapy

The original work of Paul Nogier, MD 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 innervation of four cranial nerves and three cervical ganglia. These are not acupuncture points. The professional uses a hand-held 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.