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Ask an expert - neuro and psycho logical - addiction

7 questions

Q: I have been taking drugs for 20 years, and have been on and off the wagon during this time. The longest I was clean was 8 years, when my children were small, then my husband died 4 years ago, and I fell apart. I have been using on and off, first monthly then weekly, now almost every day, combined with at least half to a bottle of wine.
I have had acupuncture once at a rehab for outpatients which I felt had huge benefits but I didn't stick it out. I was very young then.
I really need help to change the pathway of my brain. I know I can do it. and I cannot leave my children to go away to a rehab. Will acupuncture help me?

A:  We are very sorry to hear of the problems which you have had, especially since your husband's death.

There is no doubt that many people have benefited from using acupuncture treatment to help them. Although there is some scepticism in medical circles, as our review paper (rather complicated, we're afraid) shows

http://www.acupuncture.org.uk/arrc/public-review-papers/substance-abuse-and-acupuncture-the-evidence-for-effectiveness.html

there has been a considerable amount of work done to see whether treatment can help with drug dependency, not least because understanding these mechanisms could help with pain relief in a wider setting.

The most obvious first port of call, if you have to juggle a number of factors in your life, is to one of the many thousand practitioners who offer ear acupuncture/auricular acupuncture as a way of beating the craving. There are three organisations who between them represent well over 10,000 practitioners using this form of treatment. They are:

NADA-UK  http://www.nadauk.com/

SMART UK http://www.smart-uk.com/

MACRWG  http://www.macrwg.org/

This may be the most effective way to get started with the focus primarily on getting the habit under control. Each of these groups has a very clear search facility and you should be able to find a group near you where you can get the help and support you need.

Of course, you will recognise more than most how many factors are involved in addiction, and it may well be that you could benefit from some form of counselling or therapy to address the patterns which take you back to drugs and alcohol. The groups we've mentioned all have access to or can point to people specialising in this type of work.

Many of our members treat people with addictions because one of the strengths of Chinese medicine is that it treats body, mind and spirit as one, thereby picking up problems at all levels in the way that someone functions. Not all of our members may be willing to take this on; it requires a certain amount of experience to deal with addiction and some newer graduates may feel that they are out of their depth. However, we have no doubt that you could well derive some benefit.

The best way to start, though, in our view, is to try some of the systems aimed specifically at substance abuse, and then progress from there as and when you're ready.

We wish you well.

Q: I have been receiving acupuncture 2x/week for 3.5 months. She has done a great job in relieving benzo withdrawal symptoms. But the last two weeks...the constant cycling back and forth of sweating and chills has gotten much worse. Constantly showering and stripping and changing cool to warm clothes Is wearing me out. Cannot function at all. Any thoughts?

A: First and foremost we think the best thing to do is to discuss this directly with your practitioner. If she or she has done a good job in helping you through the withdrawal symptoms it suggests that he or she has a good handle on what is going on with your system. There are a number of functional disorders as understood in Chinese medicine which can lead to strange and unpredictable changes in body temperature, and while the parts of the system which cause these may not the actual problem they will point clearly to what may be malfunctioning. Given that the practitioner knows the primary imbalances well, it should be a relatively straightforward matter to follow the trail and adjust the treatment accordingly.

Depending on the extent of your dependency it might just be a final flourish of the energetic disturbances making its way to the surface. It is not unknown when treating, for example, recovering alcoholics for there to be a kind of honeymoon period where everything seems to be going really well and then a sudden outburst of rashes, hot sweats and other unpleasant symptoms which we have always understood in terms of the Chinese wisdom that disease often progresses from the exterior to the interior so that when the process is reversed there can be a sudden upsurge in unpleasant but transient symptoms. 3.5 months after treatment started would be a little unusual for this to happen, but could not be entirely ruled out. Most of the benzo withdrawal websites are at pains to point out that it can take a long time for all of the side effects of withdrawal to subside, and temperature changes akin to the kind of things people experience in anxiety or panic attacks are a common feature/

The problems you are experiencing sound may also have a conventional medical explanation, though, and it would be wise to visit your GP and try to arrange for a series of blood tests, especially tests of hormone levels. When people are having acupuncture treatment it is tempting to see everything that happens as a consequence of the treatment, which applies to both practitioner and patient alike. This can sometimes be entirely contingent, though, and testing bloods may reveal a hormonal imbalance which is driving this unpleasant process along, or some other physiological problem. Whether this is treatable with conventional medicine or whether you simply let the practitioner know so that they can adjust the treatment they are giving is your call.

There isn't a great deal more that we can say. You have done a great job in coming off benzodiazepines; not many people realise just how addictive they can become and how hard the process of withdrawal can be. We suspect that this may still be a part of that process, but if your treatment so far has been beneficial in helping you along, there is no reason why it should not help you to deal with this phase. Your practitioner is best placed to deal with this.

A:  We drew up a review paper some years ago

http://www.acupuncture.org.uk/arrc/public-review-papers/substance-abuse-and-acupuncture-the-evidence-for-effectiveness.html

which summarises the use of acupuncture treatment for a number of substance abuse problems, and as you can see in the paper, the evidence for the use of acupuncture is relatively positive, although the trials undertaken are often methodologically flawed and rather small to be used as a basis for definitive statements. The most recent systematic review in 2009 reached this conclusion, and nothing significant has been published more recently to change this view.

However, although mainstream acupuncture treatment is used to deal with the problems of alcoholism, there are a great many projects which use a more limited form of acupuncture, ear acupuncture or auricular acupuncture as it is often known. There are two very large national groups, NADA-UK (www.nadauk.com) and SMART-UK (www.smart-uk.com) whose members offer the five-point protocol and other formula treatments for helping people to deal with the problems of alcohol, and details of where practitioners can be found are on both websites. A great deal of their work is done in drop-in facilities, and some provide additional support and counselling as a part of the service.

There are also a substantial number of practitioners who belong to the Microsystems Acupuncture Regulatory Working Group which is registered with the PSA-accredited Complementary and Natural Healthcare Council. This group includes a number of organisations whose members offer more sophisticated auricular treatment than simple protocols, and their details can be found here (http://www.macrwg.org/).

This does not mean that the ordinary BAcC member does not treat people with alcohol problems, and many do to great effect. Our experience, however, is that the group setting of the detox projects often adds considerable value to the treatment through the peer pressure and encouragement which abounds. It may still be worthwhile seeking the advice of a local BAcC member, however. There are huge variations in the experience of alcoholism, from falling down drunk to a simple realisation that the end of work day drink is becoming a necessity rather than a treat, and our members may well be able to provide exactly what someone needs.

We think this remains basically sound advice. There are a number of issues with which one has to be careful. There is certainly an argument which we have heard advanced by many colleagues that using five-point protocols is all very well, but going to a professionla acupuncturist who treats the person and not just the condition can offer some help in treating the causes of addiction as well as the addiction itself, and we have some sympathy for this view. In fact, we have had our own patients for whom the driver for their addiction problems was an imbalance which we were able to help resolve.

However, many of the problems which lead to someone becoming addicted to alcohol or any other substance are very complex, and being able to negotiate the difficulties is something for the expert, not the gifted amateur. We have seen colleagues get themselves into very uncomfortable situations by gettig out of their depth, and we always advise them that being part of a multi-disciplinary team is pretty much always the best way to help people come to terms with and control their addictions.

Q:  Please do you have a list of acupuncturists who specialise in addictions therapy - especially in relation to gambling addictions?

A: Sadly we are not aware of anyone who specialises in the treatment of gambling addiction, nor are we entirely sure that acupuncture as a therapeutic intervention would be sufficient in itself to deal with this problem. There is usually, to use the jargon, a multifactorial approach, in which acupuncture is but one component.
 
There is very little by way of research in this field. If you google 'acupuncture' and 'gambling addiction' you will find a report commissioned in Ontario which concluded that acupuncture could at best be described as having a small but relatively unimportant effect and probably no effect at all. The study is well designed, although from a Chinese Medicine perspective the variety of treatments seems a little spartan. CM is predicated on individual treatments tailored to the unique needs of the patient, and delivering the same treatments to an entire group would not always be appropriate. However, the points used were some of the more powerful on the body and if there were to be an effect, they would surely generate it.
 
You may find that some of the groups contained within the acupuncture microsystems group registered with the CNHC might extend their work in auricular acupuncture to gambling. This database can be found at www.macrwg.org. There are also two organisations, NADA UK and SMART UK which deal with alcohol and drug addiction, each having several thousand members using the five point protocol and similar techniques. You may also find that these have a number of people who have dealt with gambling addiction.

 

 

In general, we tend to believe that Chinese medicine, treating as it does the person as much as the condition they have, can achieve some fairly extraordinary changes in all manner of conditions. For problems such as addictions, however, we tend to be more cautious, especially since we are aware that it often requires a more experienced practitioner not to be outflanked by a patient who is often very skilled at avoidance and deception.

 

 

 

It is always worthwhile talking to a BAcC member local to you to see what advice they can offer directly, and they may be aware of local initiatives. There are also practitioners in various fields such as hypnotherapy who may be able to offer solutions, but these are notoriously difficult to sort out by virtue of qualification alone, and a personal recommendation would be extremely useful. This 'expert' rather likes the approach taken by people using Ericksonian hypnotherapy methods, but these are also used in business coaching and not everyone who claims to be using the technique will necessarily be able to deal with a problem like addiction. 

 

We drew up a review paper some years ago

http://www.acupuncture.org.uk/arrc/public-review-papers/substance-abuse-and-acupuncture-the-evidence-for-effectiveness.html

which summarises the use of acupuncture treatment for a number of substance abuse problems, and as you can see in the paper, the evidence for the use of acupuncture is relatively positive, although the trials undertaken are often methodologically flawed and rather small to be used as a basis for definitive statements. The most recent systematic review in 2009 reached this conclusion, and nothing significant has been published more recently to change this view.

However, although mainstream acupuncture treatment is used to deal with the problems of alcoholism, there are a great many projects which use a more limited form of acupuncture, ear acupuncture or auricular acupuncture as it is often known. There are two very large national groups, NADA-UK ( http://www.nadauk.com/) and SMART-UK (http://www.smart-uk.com/) whose members offer the five-point protocol and other formula treatments for helping people to deal with the problems of alcohol, and details of where practitioners can be found are on both websites. A great deal of their work is done in drop-in facilities, and some provide additional support and counselling as a part of the service.

There are also a substantial number of practitioners who belong to the Microsystems Acupuncture Regulatory Working Group which is registered with the PSA-accredited Complementary and Natural Healthcare Council. This group includes a number of organisations whose members offer more sophisticated auricular treatment than simple protocols, and their details can be found here (http://www.macrwg.org/).

This does not mean that the ordinary BAcC member does not treat people with alcohol problems, and many do to great effect. Our experience, however, is that the group setting of the detox projects often adds considerable value to the treatment through the peer pressure and encouragement which abounds. It may still be worthwhile seeking the advice of a local BAcC member, however. There are huge variations in the experience of alcoholism, from falling down drunk to a simple realisation that the end of work day drink is becoming a necessity rather than a treat, and our members may well be able to provide exactly what someone needs.

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