Could a 2,000-Year-Old Treatment Help With Addiction?

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Substance use disorders are a growing cause of morbidity and mortality worldwide. In the United States, excessive alcohol use is responsible for 1 in 8 deaths in adults aged 20-64. [1]

More than 106,000 people in the U.S. died from a drug-involved overdose in 2021, a fatality total that has risen steadily over the last two decades. [2]

Cigarette smoking causes more than 480,000 deaths annually and life expectancy for smokers is at least 10 years shorter than for a nonsmoker. [3]

These numbers tell just a small piece of a story that chronicles devastating effects on mental and physical well-being, relationships, and our culture at large.

Pharmaceutical options for substance use disorder treatment exist, but these treatments often come at the cost of side effects and dependency. Psychotherapy and support groups play a role in helping patients to achieve and maintain sobriety, but relapse rates remain high.

Classical Chinese medicine, from which acupuncture arose, is an ancient science that seeks to describe the human being and the origins of health and disease. The Huang-di Nei-jing is largely considered the source of Chinese medical theory and was compiled between 300 and 100 B.C.E. [4, 5]

In Chinese medical theory, the human body is considered a network of complex and interconnected processes, which are governed by the complements of yin and yang. These opposites are not considered material entities or forces, but rather concepts that describe how things function in relation to one another. [5]

When yin and yang are balanced, a state of health and well-being is achieved, but when unbalanced, illness prevails. [4]

Qi is another important concept in Chinese medicine. It is sometimes described as vital energy, although an adequate translation into English is not so easy. It is more poetically described as “the fundamental quality of life,” “the pulsation of the cosmos,” or “energy on the verge of becoming matter.” [5]

The counterpart to the dynamic and transformative qi is xue (or blood), a soft and nurturing energy. [5] The channels that carry qi and blood through the body are known as jing-luo or meridians. These are described as an “invisible lattice that links together all the fundamental textures and organs.” [5]

Acupuncture is the insertion of very fine needles into points on the skin that correspond to meridians with the intention of rebalancing bodily disharmonies. [4, 6] When performed by a skilled practitioner, acupuncture can “reduce what is excessive, increase what is deficient, circulate what is stagnant, and stabilize what is reckless.” [5]

In 1973, Wen and colleagues serendipitously observed that acupuncture at specific points relieved opiate withdrawal symptoms in a patient addicted to heroin [7]. This led to further studies confirming the effect, and the development of an acupuncture protocol [6,7].

Over the next few decades, the National Acupuncture Detoxification Association protocol was adopted in many Western countries in inpatient and outpatient rehabilitation facilities [7]. Since then, conventional research has explored the mechanism of action and efficacy of acupuncture in the treatment of substance use disorders and withdrawal [7].

In the brain, drugs of abuse produce large increases in dopamine release from the nucleus accumbens (NAc), a part of the neural circuit that controls reward-seeking in response to cues, and one which has been implicated in addictive behaviors [6]. Neurochemical and behavioral evidence has shown that acupuncture can suppress the reinforcing effects of abused drugs by modulating dopamine neurons [4].

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Several brain neurotransmitters such as serotonin, opioid, and amino acids, including GABA, have been implicated in the modulation of dopamine release through acupuncture [4]. Stimulation of an acupuncture point called shenmen (HT7) in rats treated with repeated morphine administration has been shown to inhibit the sensitization of dopamine release in the NAc [8, 9].

Other animal studies have shown that HT7 acupuncture prevents alcohol-induced dopamine depletion in the NAc and behavioral withdrawal signs during alcohol withdrawal. [8,10]

Neuroimaging studies have shown interesting results. One study attempted to find changes in fMRI in relation to acupuncture stimulation at the Hegu (LI4) point. Of the 13 normal subjects who were tested, 11 of them experienced what is known as a deqi sensation at the acupuncture point, a sensation of numbness and swelling that many acupuncturists believe is necessary for achieving the therapeutic effect, while two of them experienced a sensation of pain.

The patients who experienced deqi had decreased activity in the limbic system (including the mesolimbic pathway). The ones who experienced pain had increased activity in this region, and the control patients who had superficial tactile stimulation had activation primarily in the somatosensory cortex [8, 11].

These findings were confirmed in a subsequent fMRI study and provide further evidence that acupuncture affects the circuit where dopamine serves as a primary neuromodulator, thus providing a potential pathway for reducing addictive behaviors [12].

Clinical studies examining acupuncture in the treatment of substance use disorders have been less impressive. Early trials in the 1970s of patients with drug addiction found that acupuncture effectively lowered adrenocorticotropic hormone (ACTH) and cortisol levels [13].

A recent systematic review of 41 studies with 5,227 participants with substance use disorder found a significant difference in favor of acupuncture versus controls for withdrawal symptoms and substance cravings post-intervention, but these were not significant at longer follow-ups. No significant difference was noted for relapse, frequency of substance use, or treatment dropout [14].

In 2009, a systematic review of 11 studies assessing the efficacy of acupuncture in the treatment of alcohol use disorder found mixed results, as trials were few and not of high methodological quality [15]. A review of six randomized control trials evaluated the use of the NADA protocol in the treatment of cocaine addiction and found no statistically significant evidence to suggest its efficacy [16].

Acupuncture is quite difficult to study using Western biomedical research methods. Some issues include the wide variability in techniques and practitioner experience, as well as the difficulty in standardizing procedures and satisfactory control groups [17].

Furthermore, Chinese medicine is based upon a unique philosophy that does not fit neatly into the Western framework. Two patients presenting with the same clinical complaint may receive completely different acupuncture treatments depending on physical examination and other factors.

Despite the challenges in standardization and translation into the Western model, further research is necessary to explore the value of acupuncture in the modern world. This technique has survived for thousands of years, carrying the potential to ameliorate disease processes both ancient and novel, including substance use disorders that plague our societies at an alarming rate.