Counseling

MICHAEL O. SMITH, MD, Dac**
SUNEEL VATSYAYAN MSW, ADS (NADA)***

More than 100 counselors, Social workers, Doctors, Yoga therapists and Peer Support Counselors from different parts of India have been trained to use ear acupuncture for addiction treatment and Rehabilitation as per NADA five-point treatment protocol. These people who are already working in different addiction treatment settings have completed seventy hour apprenticeship training as Acupuncture Detoxification Specialist (ADS). The model put forth by NADA allows an ADS to practice the limited, pre-defined five point needle protocol for the treatment of addictions. The ADSs do not do differential diagnosis or treatment; their role is somewhat analogous to a technician, although the word specialist more accurately captures the clinical reality of providing addiction treatment. As stated in the NADA brochure, “If ADS training and practice were restricted to acupuncturists and physicians, a very few treatments would be done and a great resource would be lost.” These ADS are using ear acupuncture in therapeutic community (T.C.) based Drug treatment programs, Drug Counseling centers, Govt. run Beggars Homes and Workplace Alcohol and Drug prevention program and Govt. funded De-addiction and Counseling centers. There are State education approved training sites in Sullivan country, Kingston, Albany, Syracuse and Rochester. Since the landmark legislation was passed in 1988, more that 150 programs in New York are using acupuncture as an adjunct for drug and alcohol treatment. The Lincoln acupuncture model is used by 1,000-program worldwide. Most of this expansion has occurred in public institutions like hospitals, correctional facilitates, and street out-reach components. These programs represent a broad range of cultural settings including Saudi Arabia, India, Nepal, and Trinidad, in addition to most Western and Eastern European countries. Independent NADA training, treatment, and certification programs have been established in more than ten countries during the last decade.

The Lincoln Hospital (New York) model can be summarized and defined as follows: (1) Clinicians use three to five, ear acupuncture points – including sympathetic, shenmen, lung, kidney, liver. (2) Treatment is provided in a group setting for duration of 40-50 minutes. (3) Acupuncture treatment is integrated with conventional elements of psychosocial rehabilitation. (4) Several components of the Lincoln program are frequently combined with acupuncture in other treatment facilities. These items include: a supportive non-confrontational approach to individual counseling; an emphasis on Narcotics Anonymous and other 12- Step activities early in the treatment process. The NADA was established in 1985 to increase the use of the Lincoln model and to maintain quality and responsibility in the field. (NADA Literature clearinghouse is listed as a reference). H.L.Wen, MD, of Hong Kong was the first physician to report successful use of acupuncture treatment of addiction withdrawal symptoms (Wen 1973). He observed that opium addicts receiving electro-acupuncture as post-surgical analgesia experienced relief of withdrawal symptoms. The lung ear point was used. Subsequently, Wen conducted several basic clinical pilot studies that formed the basis of further research.

It is very important to realize that acupuncture is only one component of substance abuse treatment. The value of acupuncture lies partly in the relief of withdrawal symptoms, but the more critical goal is to prepare the client to participate effectively in all phase of treatment and rehabilitation.

Acupuncture has many characteristics in common with 12-Step programs followed by Alcoholic Anonymous (AA )and Narcotic Anonymous( NA). It uses group process in a tolerant, support-live, and present – time oriented manner. Participation is independent of diagnosis and level of recovery. Both approaches are simple, reinforcing, nurturing, and conveniently available. The emphasis on ‘self – responsibility’ is common to both systems. In practice, acupuncture provides an excellent foundation for 12 Step recovery. Patients seem less fearful and more receptive when they first enter the meeting. The traditional advice: listen to learn and learn to listen fits this model well. There is less guarding and greater ability to support each other warmly. The ability to use 12-Step meetings, provides more stable support for continuing treatment on an outpatient basis.

  • Ear Acupuncture is a non – verbal process.
  • The treatment will be just as helpful if the patient lies to us.
  • The treatment will be just as helpful if the patient is ashamed to speak about certain issues.
  • Patients will be able to learn about themselves and process troublesome issues more gradually and comfortably.
  • The patient can be engaged in helpful treatment even before they are able to tolerate intense or personalized, one to one sessions.
  • The process of transference can be delayed.
  • Needy, fearful patients can be engaged in treatment before they can tolerate a bonding relationship with staff.
  • Paranoid, antagonistic patients are able to accept help in spite of their lack of trust.
  • Patients with low self-esteem and a lack of hope can begin their treatment participation at a realistic level.
  • Patients who are also trauma victims will be able to participate in treatment even though they are fearful of interpersonal relations
  • A much wider selection of patients can be introduced to substance abuse treatment.
  • Acupuncture provides a solution to some of the paradoxical problems in addiction treatment.
  • Patients can be treated before assessment and diagnosis are completed so that the patient can be calm and cooperative enough for a useful diagnosis to be made.
  • Confrontation about drug use is not necessary because a patient can be helped even while they are in denial about the need for treatment.
  • It is possible to provide kind, soothing, attention without the risk of enabling the addictive process.
  • Developing trust between the therapist and patient is much easier.
  • The patient can relax without losing control.
  • Indeed, the whole program can relax without losing control.
  • Acupuncture helps the development of a meditation like state.
  • Patients become comfortable with their own thoughts.
  • Patients become comfortable with their own physical processes.
  • Patients learn to “let go” of tension and preoccupations.
  • Patients develop their own spatial comfort zones.
  • Patients learn that their private internal processes can be a source of strength and renewal.
  • Patients are able to remain comfortable while focused on source of activities.
  • The calm stability in the acupuncture setting creates a relatively timeless process. There is much less pressure to improve according to guilt- related standards.
  • Ear Acupuncture treatment in a group setting creates an environment, which is reassuring and validating. As therapists, we are welcome to join this setting. We are able to be supportive witnesses for the patient’s development.
  • Hence, patients learn and remember without being overwhelmed by distractions.

In summary, Ear acupuncture helps patients to participate in individual and group treatment sessions more effectively. It is a nonverbal, nonthreatening, “first step” intervention, that has an immediate calming effect on patients. Initial participation with Ear acupuncture has been found to improve patients’ overall treatment retention, and to facilitate their subsequent involvement in rehabilitation. *The paper was presented jointly by Dr.Michael O. Smith and Mr. Suneel Vatsyayan at 4th FINGODAP Conference funded by Ministry of Social Justice and Empowerment, Government of India, UNDCP and UNAID at Kolkotta, India, held from 3rd Jan-5th Jan 2003.

** MICHAEL O. SMITH, MD,Dac
Chairmen & Founder NADA International
*** SUNEEL VATSYAYAN MSW, ADS (NADA)
Chairman, Nada India Foundation
www.nadaindia.info
Email – nadaindia@gmail.com