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).

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

Avants ,S.K ., Margolin, A., Holford, T.R., Kosten, T.R.(2000).A randomized controlled trial of auricular acupuncture for cocaine dependence.Send to Arch Intern Med. 14-28;160(15):2305-12.
Black, S. , Carey, E., Webber, A., Neish, N., Gilbert, R.(2011).Determining the efficacy of auricular acupuncture for reducing anxiety in patients withdrawing from psychoactive drugs.J Subst Abuse Treat.  ;41(3):279-87.
Brewington, V. , Smith, M., Lipton, D.(1994).Acupuncture as a detoxification treatment: an analysis of controlled research.J Subst Abuse Treat. ;11(4):289-307.
Cowan, D.(2011).Methodological issues in evaluating auricular acupuncture therapy for problems arising from the use of drugs and alcohol.Acupunct Med.  ;29(3):227-9.
de Lorent, L. , Agorastos, A.,  Yassouridis, A ., Kellner, M ., Muhtz, C.(2016).Auricular Acupuncture Versus Progressive Muscle Relaxation in Patients with Anxiety Disorders or Major Depressive Disorder: A Prospective Parallel Group Clinical Trial.Send to J Acupunct Meridian Stud. ;9(4):191-9.
Gori, L ., Firenzuoli, F.(2007).Ear acupuncture in European traditional medicine. Evid Based Complement Alternat Med.  ;4(Suppl 1):13-6.
Gurevich, M.I. , Duckworth, D., Imhof ,J.E., Katz, J.L.(1996).Is auricular acupuncture beneficial in the inpatient treatment of substance-abusing patients? A pilot study.J Subst Abuse Treat. 13(2):165-71.
Hackl, G ., Prenner, A. , Jud, P. , Hafner, F. , Rief, P ., Seinost, G ., Pilger, E. , Brodmann, M.(2017).Auricular vagal nerve stimulation in peripheral arterial disease patients.Vasa.  ;46(6):462-470
Janssen, P., Demorest, L., Whynot, E. (2005).Acupuncture for substance abuse treatment in the Downtown Eastside of Vancouver, Journal of Urban Health .82:285-95.
Janssen, P.A. , Demorest, L.C., Kelly, A., Thiessen, P., Abrahams, R.(2012).Auricular acupuncture for chemically dependent pregnant women: a randomized controlled trial of the NADA protocol.Subst Abuse Treat Prev Policy.  23;7:48.
Kattalai Kailasam, V. , Anand ,P. , Melyan, Z.(2016). Establishing an animal model for National Acupuncture Detoxification Association (NADA) auricular acupuncture protocol.Send to Neurosci Lett.  15;624:29-33.
Kawakita, K., Okada ,K.(2014).Acupuncture therapy: mechanism of action, efficacy, and safety: a potential intervention for psychogenic disorders?Biopsychosoc Med.   20;8(1):4. doi: 10.1186/1751-0759-8-4.
Lin, J., Chan, Y., & Chen, Y. (2012). Acupuncture for the Treatment of Opiate Addiction. Evidence-Based Complementary and Alternative Medicine, 2012, 1-10.
Pomeranz ,B., Chiu, D.(1976). Naloxone blockade of acupuncture analgesia: endorphin implicated. Life Sci. 19: 1757-1762.
Rong, P.J. , Zhao, J.J ., Li ,Y.Q ., Litscher, D. , Li, S.Y. , Gaischek, I. , Zhai, X ., Wang ,L ., Luo, M. , Litscher, G.(2015).Auricular acupuncture and biomedical research--A promising Sino-Austrian research cooperation.Chin J Integr Med.  ;21(12):887-94  
Smith, M. (1979).Acupuncture and natural healing in drug detoxification. Am J Acupunct. ;7:97–107.
Stuyt ,E.B. , Voyles, C.A .(2016).The National Acupuncture Detoxification Association protocol, auricular acupuncture to support patients with substance abuse and behavioral health disorders: current perspectives. Subst Abuse Rehabil.7;7:169-180.
 Soliman, N. , Frank, B.L.(1999).Auricular acupuncture and auricular medicine.Phys Med Rehabil Clin N Am.  ;10(3):547-54, viii.
Southern ,C ., Lloyd, C. , Liu, J ., Wang ,C. , Zhang, T ., Bland, M ., MacPherson, H.(2016).Acupuncture as an intervention to reduce alcohol dependency: a systematic review and meta-analysis.Chin Med.  15;11:49.
Tan, J.Y. , Molassiotis, A. , Wang, T ., Suen, L.K.(2014).Adverse events of auricular therapy: a systematic review. Evid Based Complement Alternat Med.  :506758.
Tsai, H .,Chen ,Y.F., Lin, J.G.(1989). Effect of electroacupuncture analgesia on serotoninergic neurons in rat central nervous system. Chin. Pharmacol. J. 41: 123–126.
Viel, E. , Vanoli, A ., Melis, A. , Rocher, F. , Schipman, B. , Truong, D.(2016). Efficiency of auricular acupuncture in climacteric symptoms after cancer treatments.Climacteric.  19(3):274-8.
Wang, Y.Y ., Liu, Z. , Wu, Y.,  Zhang ,O.,  Chen, M. , Huang, L.L. , He, X.Q.,  Wu ,G.Y. , Yang ,J.S.1.(2016).Acupuncture for Smoking Cessation in Hong Kong: A Prospective Multicenter Observational Study.Send to Evid Based Complement Alternat Med.  2865831.
Washburn, A.M. , Fullilove, R.E., Fullilove, M.T., Keenan, P.A., McGee, B., Morris, K.A., Sorensen ,J.L., Clark ,W.W.(1993).Acupuncture heroin detoxification: a single-blind clinical trial.J Subst Abuse Treat.  10(4):345-51.  

 Wong, M.C., Shen, H.J.(2010).Science-based mechanisms to explain the action of acupuncture. J. Assoc. Tradit. Chin. Med. 17(2), 5–10

No comments:

Post a Comment

Appreciate your constructive and meaningful comments

Find Us On Facebook