Friday, April 27, 2018

Auricular Acupuncture for the Treatment of Addiction Disorders



Ruwan M Jayatunge MD 

Auricular acupuncture is a diagnostic and treatment system based on normalizing the body's dysfunction through stimulation of definite points on the ear (Gori & Firenzuoli, 2007). In recent years numerous descriptive reports have been published concerning the efficacy of acupuncture in alleviating withdrawal symptoms with substance abusers attempting abstinence (Brewington et al., 1994).

Auricular acupuncture or auriculo-therapy is a complementary treatment method in addiction disorders. Auricular acupuncture has been used extensively in substance abuse treatment programs, hospitals, and prisons throughout the USA and the world for the past 30 years (Stuyt & Voyles, 2016). According to Smith  (1979)  acupuncture has been used in addiction treatment facilities in the United States since the early 1970s when Dr Michael Smith began to experiment with acupuncture as an adjuvant therapy for treatment of heroin addiction at New York’s Lincoln Hospital (Janssen et al., 2005). Auricular acupuncture   is a widely accepted treatment option for substance abuse that is used in more than 700 treatment centers worldwide (Black et al., 2011).  

The French Neurologist Paul Nogier popularized auricular acupuncture. Auricles are rich in nerves; therefore a close relationship with different functions of the human body has been proved by the research teams (Rong et al., 2015). According to Lin et al (2012) in auricular acupuncture there are 5 specific areas which are located in the external ear surface:  a) Lung Point b) Liver Point c) Kidney Point d) Shen Men e) The Autonomic (or Sympathetic) Point.  Auriculo-therapy is performed by needling these specific points which are approved by the National Acupuncture Detoxification Association (NADA) of the USA. According to Hackl and team (2017) auricular nerve stimulation has been proven effective in different diseases. 

Scientific research into the mechanism of action of acupuncture began around 1950 (Kawakita & Okada, 2014). Endogenous opioid peptides were considered major candidates for a role in acupuncture’s action (Pomeranz & Chiu, 1976).  According to the neurohumoral theory, acupuncture stimulates the release of various neurochemical substances, which have an analgesic and overall relaxing effect (Wong & Shen, 2010). The amelioration of pain and illness is believed to be through the reticular formation through the sympathetic and parasympathetic nervous systems (Soliman & Frank, 1999). Some experts attempt serotonin and related descending pain inhibitory pathway theories to explain the mechanism of action (Tsai et al., 1989). 

Acupuncture inoculates minute intrusive “traumas” or lesions into the tissues, which stimulates many survival mechanisms of the body and research demonstrated that manipulation promotes tissue healing by producing biomechanical, vasomotor, and neuromodulatory effects on interstitial connective tissue (Langevin, 2002; Langevin, 2001; Wong & Shen,  2010). Furthermore acupuncture restores homeostasis in the body and stimulating anti-inflammatory reaction, tissue regeneration, and pain modulation (Wong & Shen, 2010). Analgesic effect of acupuncture could be blocked by naloxon, an opiate antagonist, which implies that the action of acupuncture could be based partly on stimulating the endogenous painkilling substances (Goldstein, 1975; Mayer, 1977;Wong & Shen, 2010).  
  
Auricular acupuncture is an accessible, non-confrontational therapy that appears to be effective (Cowan, 2011). In addition auricular acupuncture is a safe therapeutic method (Viel et al., 2016).

Clinical experience suggests that acupuncture detoxification is both safe and acceptable to those in heroin withdrawal (Washburn et al., 1993). Acupuncture has been shown to reduce craving and consumption of substances in community-based studies (Janssen et al., 2005).According a study done by de Lorent and team (2016) indicated that auricular acupuncture significantly decreased tension, anxiety, and anger/aggression. Auriculo-therapy can potentially improve the side-effect profile of morphine and other prescription opioids (Kattalai Kailasam et al., 2016). Auricular acupuncture may be a safe and feasible treatment to assist chemically dependent pregnant women to reduce their dosage of methadone (Janssen et al., 2012).

According to Avants and group (2000) acupuncture shows promise for the treatment of cocaine dependence.  Southern and team (2016) indicated that acupuncture was potentially effective in reducing alcohol craving and withdrawal symptoms. Furthermore acupuncture is a safe method for smoking cessation and effective in helping smokers to quit (Wang et al, 2016). Moreover no serious adverse events were identified with auricular therapy (Tan et al., 2014). Auricular acupuncture thus appears to be a safe and inexpensive treatment modality that is easily administered and produces significant results (Gurevich et al., 1996).

Acknowledgment
Brian Irving RP, CACII, RCS Registered Psychotherapist Certified Addictions Counsellor Registered Clinical Supervisor ;Toronto Canada

References
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