ACUPUNCTURE & SMOKING
Some recent reports have suggested that there is no evidence for the beneficial effect of acupuncture on smoking reduction and cessation. A new Norwegian study however has shown otherwise, demonstrating that:
a) different acupuncture points have different effects on smoking reduction,
b) appropriate acupuncture treatment can help smokers reduce their cigarette consumption or quit entirely, and that the effects last at least five years, and
c) that acupuncture alters the subjective taste of smoking.
The study, designed to determine the long term benefits of acupuncture on smoking cessation, randomly assigned 46 smokers (smoking around 20 cigarettes a day) to a treatment group (TG) or a control group (CG). The TG received 2 treatments a week for 3 weeks at known effective anti-smoking points whilst the CG received similar treatment but at presumed ineffective points. Both groups were asked to stimulate ear points four times daily during the treatment period. During the study period, cigarette consumption fell on average by 14 cigarettes per day for the TG and 7 cigarettes per day in the CG. For both groups, reported cigarette consumption rose on average by 5-7 cigarettes during the following 8 months, and there was no systematic change thereafter. Thus the TG showed a maintained reduction in overall smoking with no change in the CG. The TG reported that cigarettes tasted worse than before the treatments, and also the desire to smoke fell. For TG the serum concentration of cotinine fell, confirming the reports of reduced smoking.
Results
After the final treatment, 32% of the smokers in the TG had quit smoking. Eight months after the end of treatment 23% still did not smoke, a figure which fell to 18% after 5 years. None of the smokers in the control group quit smoking at either of those follow-up periods.
(Preventive Medicine 2001;33:364-372).
The Successful Use of Auricular Acupuncture in the Supported Withdrawal and Detoxification of Substance Abusers
by Simon Fidler
This is an edited version of an interesting and extensive report/study of the use of acupuncture in drug addiction. Copies of the full report can be obtained buy contacting the address at the end of this document.
Acupuncture has become widely available from private practitioners in the UK in recent years. Its significant rise in availability and popularity has coincided with increased interest in a number of so called ‘complementary therapies’ which mainly emanate from the Far East. Acupuncture is commonly considered by Western medical practitioners to have little more credibility than many other ‘complementary therapies’ and is often dismissed by them along with ‘alternative’ treatments with little or no history or proven efficacy. However, the rapid increase in acupuncture practitioners in the UK and the relatively high cost of this particular ‘complementary therapy’ suggests many people are convinced it should not be so readily dismissed as just another trendy and unproved form of medicine.
One of these community based services, The Gateway Clinic, is within the National Health Service and provides treatment on a drop-in basis five days a week. A wide variety of stress related conditions are addressed by the “formula” type of detoxification acupuncture provided at this Clinic (see Appendix 6.4) which is part of the West Lambeth Community Care Trust. The cost of treating an individual in this way, five times a week and with reusable needles, is only 50 pence (35 cents) per week. In addition to this stress-management acupuncture this Service also offers Chinese Herbal medicine and full body acupuncture to those considered in need of these treatments.
Acupuncture is an extremely old Chinese mode of treatment now practiced all across the globe. It focuses on increasing the flow of energy in the body. By applying extremely thin needles at set places in the body, the equilibrium is restored. In 1972 Dr. H.L. Wen, a Hong Kong neurosurgeon, accidentally discovered the usefulness of acupuncture in treating drug addiction. He was treating a patient for a concussion. The patient was also known as an opium addict and Dr. Wen proposed a cingulutomy as treatment for the addiction. A cingulutomy is a prefrontal lobotomy that severs certain functions between the two frontal hemispheres. The patient was anaesthetised using acupuncture. Even before the operation began, the withdrawal symptoms were reduced and even disappeared altogether. The operation was cancelled. Every time the withdrawal symptoms occurred again, the patient was treated with acupuncture until they stopped occurring at all.
In Europe and America, acupuncture has been used since the early 70s in clinical and outpatient treatment programs for alcohol and drug addiction. The role of acupuncture is a modest one and has not really developed much further than in Dr. Wen’s practice in Hong Kong, i.e. to help patients during the withdrawal stage. Heroin addicts who come to a clinic for detoxification can chose between switching to methadone or stopping altogether with acupuncture. If they opt for acupuncture, then twice a day for three days and once a day for the next three days, thin needles are inserted in five spots in their ear and one spot on their hand, between the thumb and index finger. The points on the ear have their reflex to different bodily functions or organs. The effect of these different points is that they make people feel more relaxed, alleviate anxiety and uneasiness and reduce perspiration, intestinal cramps, watery eyes and sneezing. The excretion of toxic substances is reinforced, so the patient feels better faster.
There are no substitutes for cocaine and hashish addicts to help them stop using drugs. Acupuncture is the only alternative and most people accept it, since they feel that even if it doesn’t do any good, it still can’t hurt. The treatment of hashish and cocaine addicts with acupuncture is mainly focused on re-establishing an emotional equilibrium.
Although many people are skeptical about acupuncture, in general cocaine addicts turn out to be quite satisfied with it. The results with hashish addicts have been less positive. After they stopped smoking hashish, traces of THC, the active ingredient in hashish, remain in their urine for weeks, whereas within three days, the urine of cocaine users is clean. A heavy hashish smoker is apt to exhibit such symptoms as restlessness, depression and craving for quite some time. Experience has shown that this category of addicts often prematurely drop out of the clinical as well as the outpatient treatment programs. Acupuncture is effective in reducing mood changes, irritability, insomnia and fatigue.
Auricular acupuncture has successfully been used within the county of Hampshire by the Winchester drug problem team, Highclere detoxification center and Face to Face Dasein. All practitioners were fully trained and in some cases electro stimulation was used over a period of five years. e.g. Face to Face Dasein. Other treatments are also used to compliment the acupuncture.
Moxibustion involves stimulating acupuncture points with heat. It introduces energy into the body either by heating the needle or the skin with a moxa stick or by burning moxa directly on the skin (moxa is the dried leaves of the Herb artemisiae vulgaris latiflora).
Electrostimulation enhances the effect of the needles and can be used to either stimulate or sedate. Different frequencies produce different physiological responses in the body. (Transcutaneous Electrical Nerve Stimulation) machines can be useful in treating anxiety and pain.
Other treatments supplied and/or advice provided:
• Herbal teas – detoxification or sleep
• Relaxation techniques
• Dietary advice – usually high C protein
• Bach flower remedies
• Vitamin supplements
A clients perspective
“Acupuncture has, without a shadow of a doubt helped in a great way to correct those issues, bringing back the balance in the body which has been out for so long. My personal view of myself now is completely different being more assertive, confident, less anxious, determined to do something positive with one’s life. When I detoxified before I remained clean for 7/8 weeks and through that time I was timid, shy as well, thoughts of what was the point of carrying on all solved with one hit or dose. The other thing I find with seeing my acupuncturist is I see her as my therapist as well. Every time I have treatment we initially spend 5/10 minutes on talking about how I am, any problems, cravings, which after my 2 3rd session have subsided to nothing, care of addiction/endorphin points in acupuncture.”
In 1973 Wen and Teo reported that a new approach to relieving the drug withdrawal syndrome and counteracting drug addiction itself, had been used in the Tung Wah and Kwong Wah Hospital in Hong Kong – ‘By means of acupuncture with electrical stimulation, a form of treatment which had not been attempted before. By November, 1972, 40 drug addicts had been treated by acupuncture with electrical stimulation. The technique used involved needling the patients’ ears on each side, subcutaneously for half a centimeter in the middle of the cavum conchae. The acupuncture point used is the ‘lung’ point on the ear. After cleansing the ear with an alcohol sponge, a sterile acupuncture needle is inserted and the needle connected to an electrical stimulator. The frequency of the current is gradually increased from 0 to 125 hertz. The intensity is increased until the patient feels the flow of current but without causing pain. The length of treatment varies in each individual but on average lasted for half an hour.
Within ten to 15 minutes the patient confirmed that the eyes, nose and mouth were dry; aching, shivering and abdominal pain were gradually disappearing; the breathing became more regular; the patient felt warm and relaxed. Of the 40 cases, 39 were discharged free of drug addiction. Within four months eight returned to have one or two repetitions of the treatment.
It was the comparison of these two groups which concerned this study. The results were the electro-acupuncture group detoxified on average for eight days, compared with the methadone group’s average of 14 days. After one year’s observation, it was found that 51.42% of those treated with electro-acupuncture were still drug free, while the in the methadone group on 28.57% were still drug free.
At the Lincoln Hospital, it took more than a year to build up a generally positive reputation for acupuncture among the drug addicts treated there. By 1975 many considered trying acupuncture but the habit of relying on narcotics led them to favor methadone detoxification instead. Approximately ten to 15 patients a month chose to detoxify from heroin addiction exclusively by means of acupuncture.
The Lincoln Detox Program (USA) observed that the use of acupuncture points located in the external part of the ear gave the best results in the treatment of the opiate dependent addict. Hence, the current method adopted involving needling of the following points – ‘sympathetic’, ‘shenmen’, ‘kidney’, ‘liver’ and ‘lung’.
The method the Lincoln Detox Program used was acupuncture treatments usually given once a day to each patient. Careful selection of the acupuncture points was considered as the most important aspect of
the treatments. Usually each day different points needed to be stimulated for the treatment sessions to be successful.
In 1985 research at the University of Minnesota and the Downstate Medical Center in the United States confirmed that acupuncture substantially reduced withdrawal symptoms and the craving for drugs. A subsequent study at the Lincoln Hospital in 1988 provided further evidence of the successful use of acupuncture for the treatment of opiate dependency. Smith and Khan reported that it was the primary method of treatment for drug addiction and claimed the importance of the following functions of acupuncture:
1. relief of withdrawal symptoms
2. general relaxation and homeostasis
3. apparent enhancement of mental and physical functioning through activating the reserve capabilities of the body
Because the ear is not considered a separate organ but closely connected to channels and zang-fu organs, it is part of the body as an organic whole. It is possible that reactions can be detected at the corresponding areas of the auricle. Further, disorders from various parts of the body, including withdrawal symptoms, can be cured by needling the corresponding auricular points.
It has been demonstrated that acupuncture stimulates the production of endorphins. . The lengthy use of opiates reduces the production of endorphins, so that as soon as the drug use stops, there is a deficiency. Acupuncture can also greatly reduce the drop out rate among alcoholics. In cocaine addicts, acupuncture appears to have a particularly strong affect on the craving.
Of the three sub-groups involved in the trial at Winchester, the benzodiazepine group appeared to respond most positively, followed by the long term methadone clients and then the heroin users. All the benzodiazepine clients had been on this medication for a decade or more and yet all achieved their objectives.
Of the methadone clients who did complete both the acupuncture treatment and detoxification process 30% have since relapsed. At the time of writing 50% of the clients that detoxified from methadone are believed to still be free of opiates.
All clients felt their acupuncturist had assessed their needs highly accurately. All stated they would recommend acupuncture to others and particularly to those detoxifying from dependency forming drugs. And 75% those starting courses of acupuncture, completed them. The usual drop out rate from residential detoxification programs is nearer 50% during the first ten days of treatment.
Most of the medical doctors that work in partnership with the Team are now prepared to prescribe Lofexidine (Britlofix) to those detoxifying from opiates, despite the relatively high cost of this medication; approximately £80 ($120) for the two week course. Some are also prepared to prescribe naltraxone, the opiate antagonist, to those wishing to stay drug free with the assistance of this medication; costing approximately £40 ($60) a month for three to six months.
I should like to express thanks to clients and colleagues. But a sad note: The Social Services budget was financing the purchase of acupuncture. However, the Social Services Department subsequently agreed with the North and Mid Hampshire County Health Commission that the purchasing of acupuncture fell within their remit; as it is a bodily invasive therapy and commonly regarded as ‘complementary’ to other medical treatments. It is unfortunate that this defining of responsibility for the purchasing of acupuncture has occurred while the Health Commission is in a financial crisis and unable, therefore, to consider any new treatment expenditure whatsoever. As a consequence, the vast majority of clients have been unable to receive acupuncture whilst detoxifying or trying to remain drug free. We are currently exploring possible alternative sources of funding to enable us to continue providing this evidently effective and highly valued treatment.
Simon Fidler
Community Drug Advisory Service, St. Pauls Hospital Winchester, Hampshire, SO22 5AA England