Acupuncture & Substance Misuse/Addiction
In the UK, the prevalence of substance misuse is around 9 per 1,000 of the population aged 15-64 years, and around 3 per 1,000 inject drugs, in most cases opioids (NICE 2007). In 2005/6, around 181,000 people were using drug treatment services in England and Wales (Commission for Healthcare Audit and Inspection 2006). Also, research in England in 2005 estimated that 7.1 million people, or 23% of the adult population, could be categorised as hazardous or harmful alcohol users (Drummond 2005). Indeed, in England, 150,000 hospital admissions annually result from acute or chronic alcohol use, and alcohol use is implicated in 33,000 deaths each year (Academy of Medical Sciences 2004).
Dependence on drugs is a cluster of physiological, behavioural, and cognitive phenomena in which the use of a substance takes on a much higher priority for a given individual than other behaviours that once had a greater value (WHO 2007). Drugs of abuse include cannabis, opioids (opiates), CNS stimulants (cocaine, crack, amphetamines, ecstasy, crack), CNS depressants (barbiturates, benzodiazepines, alcohol), hallucinogens (LSD, psilocybin), and volatile substances (glues, gases, aerosols) (DTB 1997).
Opioid misuse and dependence are associated with a wide range of problems, such as overdose; infection with HIV, hepatitis B or hepatitis C; thrombosis; anaemia; poor nutrition; dental disease; criminal behaviour; relationship breakdown; lost productivity; unemployment; imprisonment; social exclusion; and prostitution, as well as withdrawal symptoms (Prodigy 2006; Gowing 2006; National Treatment Agency for Substance Misuse 2006). Problems associated with excessive alcohol use include hypertension, accidental injury, hand tremors, duodenal ulcers, gastrointestinal bleeding, cognitive impairments, anxiety and depression (Saunders 1990). The development of alcohol dependence appears to involve changes in brain neurotransmission (Littleton 1994; Tsai 1995).
Acupuncture is used extensively, and worldwide, in substance misuse treatment centres. This stems from the development of a simple 5-point auricular acupuncture protocol at New York’s Lincoln Hospital in the 1970’s, originally for drug users but subsequently extended to tobacco, alcohol and other addictive substances and behaviours. The protocol was designed to operate within Western health settings and mutual peer support systems, not as an isolated treatment.
In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body’s homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the ‘analytical’ brain, which is responsible for anxiety and worry (Wu 1999).
Acupuncture may help relieve symptoms of drug withdrawal by:
normalising the release of dopamine in the mesolimbic system. This reduces the over-stimulating effects of abused drugs and modifies behaviours associated with addiction such as those around desire and reward. Several brain neurotransmitter systems, for example serotonin, opioid and GABA, are implicated in this (Lee 2009a, Yang 2008, Zhao 2006)
reducing anxiety (Samuels 2008). Acupuncture can alter the brain’s mood chemistry, reducing serotonin levels (Zhou 2008) and increasing endorphins (Han 2004) and neuropeptide Y levels (Lee 2009b; Cheng 2009);
modulating postsynaptic neuronal activity in the nucleus accumbens and the striatum to reduce nicotine addiction (Chae 2004) and increasing corticotrophin-releasing factor to attenuate anxiety-like behaviour following nicotine withdrawal (Chae 2008)