Acupuncture/Drug Addiction

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Acupuncture: The Value of the Non-Verbal

 

 

By Michael O. Smith, MD, DAc

 

Acupuncture stimulates specific locations on the body with the goal of

altering and improving bodily function. The needles used in addiction

treatment penetrate 1/8 inch on the outside surface of the ear. This nearly

painless procedure causes the onset of a gratifying sense of comfort and

homeostasis. Many prospective patients express concern about the pain of

needle insertion, but this concern subsides when they observe other patients

undergoing the actual treatment process.

 

Acupuncture brings a non-verbal component to the addiction treatment

process. While acupuncture does not supplant the need for the counselor to

talk with the patient, it allows the verbal interaction to be quite flexible

so that a patient who does not feel like talking can be accommodated easily

and naturally. Acupuncture will be just as effective even when the patient

lies to us.

 

The most difficult paradox in addiction medicine is the common reality that

addicted persons usually deny their need for help. Such patients do not say

anything helpful in the treatment process. Nevertheless, resistant patients

often find themselves in a treatment setting due to referral or other

pressures. Using acupuncture can bypass much of the verbal denial and

resistance that otherwise limit retention of new and relapsed patients.

 

The Lincoln Hospital treatment model

Acupuncture treatment for drug and alcohol problems was primarily developed

at Lincoln Hospital, a New York City-owned facility in the impoverished

South Bronx. The Lincoln Recovery Center is a state-licensed treatment

program that has provided more than 500,000 acupuncture treatments in the

past 20 years.

 

The Lincoln Hospital model can be summarized and defined as follows:

 

* Clinicians use three to five ear acupuncture points.

 

* Treatment is provided in a group setting for a duration of 40-45

minutes.

 

* Acupuncture treatment is integrated with conventional elements of

psychosocial rehabilitation.

 

* Several components of the Lincoln program are frequently combined

with acupuncture in other treatment facilities. These items include: a

supportive, non-confrontational approach to individual counseling; an

emphasis on Narcotics Anonymous and other 12-Step activities early in the

treatment process; an absence of screening for " appropriate " patients (so as

to lessen unnecessary barriers); the use of herbal sleep mix; the use of

frequent urinalysis; a willingness to work with court-related agencies; and

a tolerant, informal, family-like atmosphere.

 

A wide range of patients can be accepted for the initial stage of treatment

because there is no verbal motivational requirement. Also, acupuncture is

effective for most drugs and a wide range of psychological states. Problems

relating to language and cultural differences are diminished. For new

patients, frequent acupuncture treatment permits the gradual completion of

assessment on a more accurate basis. Patients can be evaluated and triaged

according to their daily response to treatment and testing rather than

merely on the basis of the initial interview.

 

Bypassing barriers to effective treatment

The tolerant, non-verbal aspect of acupuncture facilitates retention during

periods when the patient would otherwise be ambivalent, fearful, or

resentful within a more intense verbal interpersonal setting. The

acupuncture makes it easy to provide outpatient treatment on demand, without

appointments, while the patients are being acclimated to the interpersonal

treatment setting. Patients are often willing to be urine-tested even when

they know that their toxicology result is positive, thereby showing respect

for the value system of the overall treatment process. Those same patients

may be unable or unwilling to share their crisis and failure verbally until

they have time to reach more solid ground. In the acupuncture setting, time

is on our side.

 

In practice, acupuncture provides an excellent foundation for 12-Step

recovery. Patients seem less fearful and more receptive when they first

enter the meetings. The traditional advice " listen to learn and learn to

listen " fits this model well. Acupuncture reduces white-knuckle sobriety

considerably. There is less guarding and greater ability to support each

other warmly. The increased ability to use 12-Step meetings provides more

stable support for continuing treatment on an outpatient basis.

 

Patients referred by court-related agencies often enter treatment in total

denial or with a basic conflict with the referring agency. The non-verbal

aspect of acupuncture allows the intake staff to get beyond these protests

and offer acupuncture for stress relief, instead of forcing the issue. Using

acupuncture we are able to wait until the patients feel more comfortable and

less threatened so that they can admit their addiction and ask for help.

 

The nature of recovery from addiction is that patients often have quickly

changing needs for crisis relief and wellness treatment. Many persons in

recovery have relatively high levels of wellness functioning. Even so, a

crisis of craving or past association may reappear at any time. Acupuncture

provides either crisis or wellness treatment using the same ear point

formula. The non-verbal, present time aspects of the treatment make it easy

to respond to a patient in whatever stage of crisis or denial that may

exist.

 

When talking hurts, and verbal bonds threaten

Addiction patients often cannot tolerate intense interpersonal

relationships. Using a conventional one-to-one approach often creates a

brittle therapeutic connection. It is easily broken by events or any stress.

Patients have difficulty trusting a counselor's words when they can hardly

trust themselves. Even after confiding in a counselor during an intake

session, a patient may feel frightened and confused about expanding that

relationship. Many of their concerns are so complex and troublesome that

talking honestly about their lives could be difficult in the best of

circumstances. The ambivalence typical of addicts makes it easy to develop

misunderstandings. All of these factors support the usefulness of non-verbal

technique during early and critical relapse phases of treatment and critical

periods of relapse.

 

A woman six months pregnant entered our clinic several years ago. She said,

" I can't tell you much about myself because my husband is out in the street

with a baseball bat, he'll hit me in my knees if I say too much. " We

provided an emergency acupuncture treatment and conducted a simplified

intake interview. Two weeks later, this patient told us, " This is my

husband, he doesn't have a drug problem, but he is nervous, can you help

him? "

 

Both the woman and her husband received acupuncture that day. The woman

needed non-verbal access to treatment because of real physical danger.

Overprotective spouses often forcefully oppose all social contacts outside

the marriage. This patient was protected because there was no premature

verbal bonding that would have threatened the husband. The whole process was

so supportive that the husband was able to trust his wife and seek help

himself. Like many fearful people, he was literally unable to make any

verbal approach on his own.

 

Adjusting the tone of treatment

Treatment programs without acupuncture are compelled to screen for patients

who are able to talk readily with authority figures. Many verbally needy

patients become quite dependent on the program and quite involved with

numerous staff members. Such patients may be the focus of many conferences,

but they are often too needy to remain drug-free outside the treatment

setting. In contrast, acupuncture-assisted intake can retain patients who

are relatively more paranoid, independent, assertive, and hostile. Noisy,

troublesome patients who are frustrated with the world and with themselves

actually may be more likely to sustain a drug-free lifestyle than patients

with verbal dependency needs.

 

Acupuncture helps a program develop an underlying environment of acceptance,

tolerance, and patience. There is ample space for the ambivalence and

temporary setbacks that are a necessary part of any transformation. Patients

can have a quiet day by attending the program and receiving acupuncture

without having to discuss their status with a therapeutic authority figure.

Since acupuncture reduces the agitated, defensive tone in the whole clinical

environment, patients are able to interact with each other on a much more

comfortable level. Their increased ability to listen to others and accept

internal changes have a profound effect on the quality and depth of

communication in group therapy sessions and 12-Step meetings.

 

Michael O. Smith, MD, DAc, a psychiatrist, is director of the Lincoln

Recovery Center in Bronx, NY. He was a co-founder of the National

Acupuncture Detoxification Association and is a speaker and consultant for

addiction treatment programs in the U.S. and internationally.