AcuDetox: with Kath Berry

Acknowledgements: Dr Chris Zaslawski, Dr Deirdre Cobbin, Dr Sean Walsh, Dr Peter Meier and Dr Joanne Ferguson

Introduction

Alcohol and other drugs (AOD) are one of the leading causes of preventable deaths in Australia. Deaths in 1998 were estimated at 17,671 and 185,558 hospital episodes were related to drug use). Drugs cost the community lives and money. Health care, road accidents and crime cost $34.5 billion in 1998 as the result of alcohol and drug use (Collins and Lapsley, 2003).

There is a wide range of licit and illicit drugs available in our community. Alcohol (38%) and cannabis (22%) were the principal drugs of concern for clients seeking treatment in 2002 to 2003, followed by heroin (18%), amphetamines and other drugs (both 11%) (Australian Institute of Health and Welfare, 2004). These drugs are all pharmacologically diverse. They have different psychotropic and physiological effects, likeability, abuse liability and dependence potential. That is, they vary in the relative probability that they will become a social, psychological, or physical problem for an individual or for society (World Health Organization, 2005).

AOD treatment is a good economic investment for Governments and the community. While there are large economic demands on health services, numerous studies have demonstrated that the benefits of providing treatment equal or exceed the costs associated with its provision (Australian National Council on Drugs, 2003). For example, for every $1 spent on AOD treatment, Gerstein and colleagues (1994) found there was a direct economic return of $7 in reduction of criminal behaviour, improved physical and mental health and increase in employment. Improved social functioning, improved relationships and wellbeing are examples of intangible benefits of AOD treatment. Despite this, treatment services in Australia are inadequately funded and have significant staff shortages (The Commonwealth Fund, 2004). There is a need to explore additional cost effective treatments to complement and support existing AOD treatment services.

Acupuncture is the most extensively studied alternative treatment for drug dependence, according to the National Health and Medical Research Council (1999).

In 2004 the University of Technology Sydney (UTS) Department of Health Sciences trialled a pilot acupuncture study at a Sydney Hospital Rehabilitation Unit. The trial involved the participation of fourth (final) year students enrolled in a Bachelor of Health Science Traditional Chinese Medicine at UTS. The students participated in a voluntary clinical placement program at under UTS clinical supervision. The trial ran for six months finishing in October 2004.

What is Acupuncture?

Acupuncture is part of a system of healing known as Traditional Chinese Medicine (TCM) which has been practiced in China and other Eastern countries for over 2000 years. It involves the insertion of fine gauge needles into specific points on the body. The aim of acupuncture is to promote metabolic functions and restore homeostasis.

Exactly how acupuncture works is largely unknown. While the bio-physiological mechanisms for acupuncture are still unclear, there is evidence to suggest it activates the dopinergic limbic system (Scott and Scott, 1997). This system, also known as the Reward Cascade  (Blum, Cull and Braverman, 1996), is governed by the release and regulation of serotonin, an endogenous neurotransmitter. Scott and Scott (1997) suggest that acupuncture directly effects the reward cascade by increasing the amount of serotonin in the hypothalamus, the part of the brain responsible for emotion and reward.

Historical development of the use of acupuncture for AOD treatment

Acupuncture treatment for substance dependence was first reported by a Hong Kong based neurosurgeon, Dr Wen, in 1973. The article which appeared in the Asian Journal of Medicine tabled the use of electrical stimulation to a specific point (Lung) on the ear  to treat the symptoms of opiate withdrawal (Wen and Cheung, 1973).

In 1974, Dr Michael Smith, Medical Director of the Substance Abuse Division at the Lincoln Hospital New York, introduced Wen’s electrostimulation auricular (ear) acupuncture treatment (Smith and Butler-Arkow, 2001).

In 1985 Smith founded the National [USA] Acupuncture Detoxification Association (NADA) to train and certify health care professionals in using the five point auricular acupuncture protocol (Smith  and Butler-Arkow, 2001). The auricular acupuncture protocol for addiction is commonly referred to as NADA.

Recent meta analyses of NADA and body acupuncture studies for the treatment of alcohol and other drugs agree that while there is some evidence to suggest that the therapeutic effects of acupuncture are due to more than placebo, there are mixed results concerning its efficacy (Culliton and Kiresuk, 1996; Green et al, 2002; Otto, 2003).

UTS Acupuncture AOD Research Project

An uncontrolled pilot study, the trial was Australia’s first hospital based research program examining the effectiveness of [full body] acupuncture for the treatment of AOD dependencies.

The aim of the study was to determine the feasibility of acupuncture as an adjunct treatment in an existing AOD program, by investigating whether:

1. the addition of acupuncture had an effect on anxiety;
2. the addition of acupuncture increased program retention rates;
3. there are predictors for acupuncture treatment outcomes (such as gender, drug of choice and age);
4. participants perceived acupuncture to be a beneficial adjunct to their treatment program;

Results

The subjects fell into four categories determined by whether they: could not complete the program (because of time constraints); dropped out of the hospital program; elected to drop out of the acupuncture program; or completed both programs. Thirteen of the 47 subjects completed the trial, receiving four treatments (over one month) in total. With all four groups, there were statistically significant decreases in mean anxiety scores (p < 0.05)[1].

The average length of stay (number of days) in the hospital program was higher for the trial period than for the same time in previous years. However data were limited and it is difficult to draw conclusions from such a small sample size and short trial duration (21 weeks).

Discussion

Uncontrolled clinical trials are essential in new frontiers of research to determine whether the clinical effects are worth investigating.

Limitations of the study included a high drop out rate; small sample sizes; difficulties distinguishing between acupuncture and health improvements over time; difficulties disentangling the effects of acupuncture from non treatment specific health outcomes (placebo); sample and practitioner bias; no treatment prescription leading to a wide range of points selected and no post treatment follow up.

Decreases in mean anxiety scores for all the groups, increase in program retention rates and positive feedback from client satisfaction surveys suggest that further research is warranted. 

Conclusions

Despite the limitations this pilot study  has been a necessary first step. The study An Examination of the Effectiveness of Acupuncture as an Adjunct to an Alcohol and Other Drugs Treatment Program has provided a foundation on which to build an evidence base in the future.

For more information:

Katherine Berry

Email [email protected]

 References

Australian Institute of Health and Welfare (2001) National Drug Strategy Household Survey AIHW Canberra.

Australian Institute of Health and Welfare (2004) Alcohol and other drug treatment services in Australia 2002-03: Report on the national minimum data set. AIHW Canberra.

Australian National Council on Drugs (2001) Evidence supporting treatment: the effectiveness of interventions for illicit drug use ANCD Canberra.

Blum, K., Cull, J., Braverman, E (1996) Reward Deficiency Syndrome. American Scientist, March-April, 132-145.

Collins, D., and Lapsley, H (2003) Counting the cost: estimates of the social costs of drug abuse in Australia in 1998-9 National Drug Strategy monograph series no. 49. Canberra: Commonwealth Department of Health and Ageing.

Commonwealth Fund, The (2004) Australian Hospitals and the Health Care System: Views of Hospital Executives Findings from International Health Policy Survey Canberra.

Culliton, P., and Kiresuk, T (1996) Overview of Substance Abuse Acupuncture Treatment Research. Journal of Alternative Complementary Therapies, 2(1), 149-159.

Gerstein, D. R., Harwood, H. J., Suter, N. (1994) Evaluating recovery services: the California Drug and Alcohol Treatment Assessment, California.

Green, C. J., Kazanjian, A., Rothon, D. A (2002) Acupuncture in the Management of Alcohol and Drug Dependence. The University of British Columbia: Centre for Health Services and Policy Research, British Columbia Office of Health Technology Assessment.

National Health and Medical Research Council (1999) Current state of research on illicit drugs in Australia, an Information Document: (NHMRC).

Otto, K. C (2003) Acupuncture and Substance Abuse: A synopsis, with Indications for Further Research. The American Journal on Addictions, 12(1), 43-51.

Scott, S., and Scott, W. N (1997) A Biochemical Hypothesis for the Effectiveness of Acupuncture in the Treatment of Substance Abuse: Acupuncture and the Reward Cascade. American Journal of Acupuncture, 25(1), 33-38.

Smith, M. O., and Butler-Arkow, J. C (2001) Acupuncture in the Treatment of Addictions. In C. Cassidy (Ed.), Contemporary Chinese Medicine and Acupuncture (pp. 254-267). UK: Churchill Livingstone.

Wen, H. L., and Cheung, S. C (1973) Treatment of Drug Addiction by Acupuncture and Electrical Stimulation. Asian Journal of Medicine, (9), 139-141.

White, A., and Ernst, E (2001) The case for uncontrolled clinical trials: a starting point for the evidence base for CAM Complementary Therapies in Medicine, (9) 111-115.

World Health Organization (2005) Lexicon of alcohol and drug terms http://www.who.int/substance_abuse/terminology/who_lexicon/en/print.html

[1] For the initial treatment as this was the only treatment for which between group comparisons could be made because of subject drop out.