Acupuncture has been used in China for at least 2,000 years to treat a variety of disorders. The use of acupuncture for the treatment of drug addiction was discovered serendipitously in 1972 by Wen, aHong Kongneurosurgeon conducting a series of studies on the analgesic properties of acupuncture. Heroin addicts who volunteered to be subjects reported that their opiate withdrawal symptoms were lessened on the days when they received their acupuncture treatments. Wen undertook a series of uncontrolled studies on the use of acupuncture in the treatment of opiate addiction and reported positive results. Over the last 30 years, numerous studies have been undertaken investigating acupuncture for the treatment of various addictions, including opiates, tobacco, and alcohol. Many of these studies report beneficial effects of acupuncture. Not infrequently however, investigations of acupuncture for the treatment of drug addiction suffer from problems of design and assessment.
In this study we would use the findings of Professor Han Ji Sheng ofBeijingMedicalUniversityinChina. Dr. Han reported that 30 minutes of stimulation of body points with his HAN stimulator was effective in relieving symptoms of drug withdrawl. Dr. Han also demonstrated by serial numbers of human CSF that specific frequencies of electrical stimulation caused the gene expression of endorphins and other neuropeptides. HANS stimulator reduced the amount of gas anesthetic required for surgery by 50%. He showed a cross-tolerance between acupuncture and morphine. Needles are no longer necessary, as conducting polymer pads suffice.
The number of young people ages 12-17 suffering from substance abuse addiction is growing. There is also a corresponding increase in crime and suicide rates among the juvenile population. Teens are the future of this country, and solving the problem when it first starts is of utmost importance. No research on acupuncture has been done with juveniles, although a significant amount of research has been done with groups age 18 and older. Given t e limited success, to date, of pharmacologic treatments for drug addiction, and the urgency of the problem with young people, there is a need to evaluate less conventional treatment modalities. The reported clinical success of acupuncture for the treatment of alcohol and drug addiction and its increased popularity directed our efforts toward an investigation of acupuncture and herbal medicine intervention.
Aim of this study
Which method of Acupuncture is more effective for the treatment of drug and alcohol addiction: The NADA protocol alone, HANS stimulation, or NADA protocol plus HANS stimulation and Chinese herbal detox formula? Also, these three methods need to be compared to a control group.
Materials and methods
Participants: 100-200 juvenile drug and alcohol addicts, both male and female, different origin backgrounds, court ordered.
Inclusion and Exclusion Criteria
Inclusion criteria: The study would include juveniles under 18 years old, who have been diagnosed with cocaine dependence according to SCID fourth edition, who have evidence of recent cocaine use either by providing a cocaine positive urine screen at or within 2 weeks before screening or by self reporting abuse within 1 week prior. Or same age group has to meet DSM-IV criteria for alcohol dependence.
Exclusion criteria: Being dependent on ‘any substance other than alcohol, opiates, cocaine, or nicotine, currently taking a prescription benzodiazepine, currently taking any other psychotropic medication unless maintained in this medication for at least 90 days, pregnancy, clinically evident cognitive impairment, current medical conditions requiring treatment, currently receiving acupuncture in the previous 30 days, being actively suicidal or psychotic.
The control group would practice Tai Chi 45 minutes each week for 48 weeks.
Plus they would receive the helix needle insertion control. The points in the helix are as far removed from the NADA points as is possible within the compass of the auricle, and they are not located in the concha, avoiding vagal stimulation.
They also receive psychological treatment consisting of weekly individual counseling as well as weekly coping skills group.
Compare three methods, each having a 30-minute duration for 12 weeks and follow up twice a month for the next 20 months:
- NADA protocol (insert five needles into the auricle points Kidney, Lung, Liver, Shenmen and Sympathetic).
- HANS stimulator (hegu, wai guan, bai hui, ren zhong).
- NADA protocol, HANS stimulator, plus herbal formula for detox.
Drug and Alcohol use will be assessed during the study by urine toxicology screening 3 times weekly.
Measure both neurochemical and behavioral levels. Neurochemical measurements include: release of endogenous opioids, Serotonin (5HT), noradrenalin (nor epinephrine), cholecystokinin, and dopamine metabolism.
For alcohol addiction screen urine ethanol levels, 5-hydroxytryptophol, 3 times weekly. Weekly Serum GGT and CDT levels. Measure alcoholic seizures by using Mainz Alcohol withdrawal scales MAWS. For comparison between groups use ANOVA analysis. In exploratory analysis use Cox proportional hazards model.
The follow up of the study should be 2 years.
Although we could score the study according to Riet et al, using a list of 18 predefined criteria, which include validation of outcome and duration of follow up, Riet et al was criticized for only having 18 criteria that limited the ability to adequately measure clinical trials (Birch, 2001; Lewith, 1995). Birch (2003) suggests a criteria range of 43, but remains unpublished. The maximum possible score is 100. The study could use Kaplan-Meier survival estimates for withdrawal’
Mechanism of Acupuncture
The mechanism by which acupuncture may constitute a treatment for chemical dependency has not been fully investigated, although it has been conjectured that acupuncture, perhaps mediated by the release of endogenous opioids, modulates neural circuits in the midbrain also affected by drugs of abuse. Traditional Chinese theories of acupuncture involving ‘the rectification of chi deficiency or excess in various organ systems have not been adequately tested within Western biomedical frameworks. Blum and colleagues (1996) suggested that stimulating the vagus nerve, which is located in the concha and at the Lung point on the auricle with the insertion of an acupuncture needle the hypothalamus is stimulated. In that effect hypothalamic neurons release serotonin (5HT) which activates methionine enkephalin, an opioid peptide. Met-enkephalin is released at the ventral tegmental region and interacts to inhibit receptors controlling the release of GABA. Met-enkephalin and/or other opioid peptides finely tune the system. Tht primary role of GABA is to control the output of dopamine in the ventral tegmental region. The result of inhibiting GABA is an increase in dopamine. Acupuncture acts to reduce craving, thereby assisting the drug addict into selfrecovery.
U. S. Studies
Auricular acupuncture is an increasingly popular intervention for the treatment of cocaine addiction in theUnited States. Currently, approximately 200 clinics, in 32 states, offer auricular acupuncture for the treatment of this disorder (Smith 1991). Despite its increasing
opularity, auricular acupuncture has been evaluated in relatively few studies for the treatment of cocaine addiction (Lipton et aI., 1992, 1994; Margolin et al., 1992, 2002; Smith,1988, Otto et al 1998, Bullock et al 1997, 1999, Killeen et a12002, Avents et al 2000, etc). Clinical reports suggest that auricular acupuncture induces a feeling of relaxation that reduces craving for cocaine and facilitates patient participation in counseling and rehabilitation. There are few controlled studies of acupuncture for the treatment of cocaine addiction. One study conducted atLincolnHospital, (D. Lipton,V. Brewington, and M. Smith, unpublished data) another one from the Substance Abuse and Treatment Unit, Department of Psychiatry,YaleUniversityschoolofMedicine. Cocaine use was determined by urine toxicology screenings. Depression was assessed by using the Beck depression inventory. Self-representation was assessed using the modified selves Questionnaire, etc. The authors report a positive finding for acupuncture insofar as subjects who received real acupuncture and remained in treatment for over 2 weeks had significantly lower levels of benzoylecgonine in urine screens compared to the placebo group. Sixty-one percent of women and 36% of men who entered the study completed the entire 8-week course of acupuncture treatment. All of the women and 60% of the men who completed the study attained abstinence. Among the HIV-positive patients 38% completed the study, of these individuals 83% attained abstinence. In the pharmacotherapy trial, retention in treatment was excellent, and abstinence rates were modest. In the acupuncture study, the retention rate was lower, but the patients who remained in treatment did extremely well. No subject reported dropping out of the studies because of an adverse response to acupuncture treatments. Subjects who attained abstinence in these studies exhibited decreased Beck Depression Inventory scores, a shift in self-representation away from “addict” and toward desired “nonaddict” self-schemata, decreased craving, and increased aversion to cocaine cues.