All About Addiction

Adi,
Good to see a student taking an interest in an important subject. As a Certified Alcohol and Drug Counselor working in an inpatient subacute acupuncture-based detox program, it would not be ethical for me to recommend only "one" modality to addicted clients I work with. And while clients have told me "wow, acupuncture really helped" (I place high value on reports from my clients on what they are finding to work for them), and while I have seen observed changes in struggling clients after they receive the NADA protocol (their guard comes down, they listen better, they're more receptive, they start to smile, they appear calm and relaxed), I would never tell clients to "just" use acupuncture as the only aspect of their recovery. This would set them up for failure.

NADA trainer and acupuncturist Roger Lore said it best: "If integrative medicine means one person sits in front of a computer and rolls out research abstracts to make a complete picture of medicine, then it will never work. There is a clear need to integrate data from patients and practitioners, not just data from randomized controlled trials using placebos. The fact RCT's have been used only for the last 20 years for drug studies should give us pause."

The study you have based your conclusions on may be one of the most well-funded studies on acupuncture for addictions, but it is not the smartest one. When these researchers recommended, in the end, that acupuncture is "not a stand alone treatment for cocaine addiction," they did not prove much. The multitude of clinics that use the NADA protocol for addictions treatment do "not" use it as a stand alone therapy--therefore this CATS study does not reflect the "real world" of addictions treatment. This CATS study was a Randomized Control Trial, a study design that works well for testing pharmaceuticals, but is not adequate for measuring "evidence" of success an type of addictions treatment, or acupuncture for any condition. The top researchers in both of these fields(both addictions and acupuncture) tell us this.

The conclusions of the CATS study only prove what the 1997 National Institute of Health Consensus Statement on acupuncture already stated: that acupuncture "not" as a stand-alone therapy, but can be beneficial as adjunct to existing therapy. This follows the recommendations for use of acupuncture in addictions treatment by the National Acupuncture Detoxification Association since NADA was founded in 1985. If you--as an aspiring academic in the field of addictions--are interested in understanding not just one RCT out there, but rather the context of research of acupuncture for addictions as well as the many other studies and outcomes data that has been accumulated for decades, refer to "The Guide to Acu Detox Research," (JM Reports, 2007--available for purchase through: http://acudetox.com/bookstore/)

Experience working with recovering addicts has taught me a few things:
1--No one modality cures addiction--not "just" 12-step, not any one thing.
2--Listen to what clients say helps them to stay clean. In spite of the CATS study, I won't tell my cocaine-addicted clients not to seek acupuncture as part of their recovery plan if they find it is helping them. That would not be ethical.

I'll close with an excerpt from a manual designed for addictions clinicians, the Center for Substance Abuse Treatment's (Uncle Sam's) best practice manual for Addiction and Detoxification:
"Acupuncture is one of the more widely used alternative therapies within the context of addictions treatment. It has been used as an adjunct to conventional treatment because it seems to reduce the craving for a variety of substances of abuse and appears to contribute to improved treatment retention rates. In particular, acupuncture has been viewed as an effective adjunct to treatment for alcohol and cocaine disorders, and it also has played an important role in opioid treatment (i.e., methadone maintenance). It is used as an adjunct during maintenance, such as when tapering methadone doses. The ritualistic aspect of the practice of acupuncture as part of a comprehensive treatment program provides a stable, comfortable, and consistent environment in which the client can actively participate. As a result, acupuncture enhances the client’s sense of engagement in the treatment process. This may, in part, account for reported improvements in treatment retention (Boucher et al. 2003). A 1999 CSAT-funded study showed that patients choosing outpatient programs with acupuncture were less likely to relapse in the 6 months following discharge than were patients who had chosen residential programs (Shwartz et al. 1999).

Ear acupuncture detoxification, which was originally developed as an alternative treatment for opioid agonist pharmacotherapy, is now augmenting pharmacotherapy treatment for patients with coexisting cocaine problems (Avants et al. 2000). The advocates of acupuncture have joined with the advocates of opioid agonist pharmacotherapy to create a holistic synthesis. Each has contributed to the success of the other, both clinically and in public perception." (pp124
http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=hssamhsatip&part=A85279)

Avants, S.K., Margolin, A., Holford, T.R., and Kosten, T.R. A randomized controlled trial of auricular acupuncture for cocaine dependence. Archives of Internal Medicine 160(15):2305–2312, 2000. 1993.

Boucher, T.A., Kiesuk, T.J., and Trachtenberg, A.I. Complementary and alternative therapies. In: Graham, A.W., Schultz, T.K., Mayo-Smith, M.F., Ries, R.K., and Wilford, B.B., eds. Principles of Addiction Medicine. 3d ed. Chevy Chase, MD: American Society of Addiction Medicine, 2003. pp. 509–532.

Shwartz, M., Sahz, R., Mulvey, R., and Brannigan, P. Value of acupuncture detoxification programs in a substance abuse treatment system. Journal of Substance Abuse Treatment17(4):305–312, 1999.

It sounds like the articles you are referencing found acupuncture as good as standard treatment. That's not altogether a bad thing as we have few other alternatives. Many of the (thousands of) clients we work with here in New Mexico prefer to have a non-verbal treatment like acupuncture over counseling, but more commonly people use many different modalities to treat their substance use, acupuncture is one, counseling is one, group therapy is one, medication may be one. In fact, no single treatment has hard eveidence that it "works" long term (or even short term) in substance use treatment. It is a hard condition to crack. The most successful treatments combine several modalities along with consequences - drug courts "work" the best.

Nityamo Lian
Public Health Acupuncture of NM

This article's title is misleading. It should have been more specific. As is, it implies that this article discusses the efficacy of acupuncture treatment for all addictions. However, the primary focus of the article is severe cocaine addiction, with additional discussion about heroin addiction. The specificity of this article is hidden by the sweeping claims of the headline. For some types of addiction or for some addicts, relief from withdrawal symptoms may be enough to kick the habit. Responsible reporting will advance research more than marginally clever headlines.