Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.
Detoxification must only be done when the client is under direct medical supervision, and the NADA (acupuncture) protocol or other complementary therapies are to be used in complement to a GP or consultant doctor’s care.
Acupuncture is used widely in this field in the United States and the UK (D’Alberto, 2004; Margolin, 2003) as part of a multi-disciplinary approach within a medical team to counter withdrawal effects alongside conventional treatment, and where appropriate. The 5-point NADA (National Acupuncture Detoxification Association) protocol is the most well-known protocol that is used, and is a combination of 5 specific points on the ear.
About the research:
When reading health research, it is important to know that Systematic Reviews or Meta Analyses of a large number of high-quality research studies are the very best way to be able to say to what extent a given treatment can address a condition, symptom, or set of symptoms. The next best level of evidence is the individual Randomised Controlled Study (RCT) which uses a systematic technique to compare two or more groups of patients receiving different treatments (or a treatment against a “control”, or no treatment). In acupuncture trials, the nature of the control group is of particular interest as it is hard to blind a patient to whether they are having a needle inserted or not, and even more challenging to blind the researcher/team to this.
The means and quality of how research is carried out varies considerably from country to country, and in terms of how an intervention is compared to another intervention (or a control). Of note is the fact that “sham” acupuncture (where needles are placed in apparently inert locations rather than traditional acupuncture points) is not really an inert process as it has physiological effects, so that comparing sham and “true acupuncture” may therefore not give a clear picture alone; but and form a part of a research body where acupuncture versus no treatment, vs conventional treatment or vs a different approach/modality also form part of the evidence base.
The n= figure (where quoted in research) tells you how many people were participants in the study, and usually the larger a study (when it is of good quality and design), the more likely it is to be reliable and applicable to larger populations. When (statistical) “significance” is discussed in view of studies it has a very particular meaning – it is the confidence in the data (using statistical tests) that tells us how likely a result could have just come about by chance. The lower the possibility of a chance result, the more likely it is due to the intervention in the experiment. When you are reading a trial/study, the “p” is the number telling us of significance, and this must be under 5% (or p less than 0.05) to mean we can say it is a (statistically) “significant” result.
This is a much-researched area: a scholarly search of the available research studies on “acupuncture and addiction” reveals over 30,000 papers from journals, and narrowing this to “RCT” leads to over 2,300 hits, of which 41% since 2017.
From the amount of research that has been done, this we can deduce that acupuncture is both widely applied, and subject to scientific research in these areas, and that the pace at which the research is being carried out is increasing – leading us to understand this is an area worthy of scientific examination and consideration.
Systematic reviews that have been carried out – (all full references are below): Ge et al, 2020: illicit drug withdrawal syndrome – 30 trials and n=2391; Wang et al, 2019 – smoking cessation, 24 trials and n=3984; Chen et al, 2018 – opioid use disorder, 9 studies and n=1063; Dai et al, 2021 – smoking cessation with 6 treatment arms as comparisons – 23 studies, n=2706; Liu et al, 2018 – alcohol withdrawal syndrome, 11 RCTs and n=875. Systematic review outcomes have been mixed, with some tentatively positive, but consideration is to be taken as to the quality of some of the research papers, and additional study is warranted.
More recently this year there have been two Systematic review protocols published to look at RCT’s for acupuncture and withdrawal from opiate addiction (Zhang et al, 2021; Chen et al, 2021 & Chen at al, 2020 in the BMJ). It will be interesting to see the results of the latter three ongoing systematic reviews as these are published, two of which are looking at opiate addiction and one at internet addiction.
There has also been some interesting discussion on the use of alternative analgesia, with particular emphasis on acupuncture as regard the current iatrogenic opioid crisis in the Unites states (Fan et al, 2017 – White Paper), whereby acupuncture has been mooted as playing a potential role in this picture, with Lee et al, (2019)’s protocol for systematic review being another upcoming paper on the matter.
The NADA, or National Acupuncture Detoxification Association protocol is a set of 5 acupuncture points on the ear (also known as auricular acupuncture), which has been used since the 1970’s for many conditions involving addictions. Whilst the initial development was for substance abuse, it has latterly been used for food addiction and obesity (Chen at el, 2018); nicotine addicion / smoking (Leung, 2012) as well as trauma and PTSD (post traumatic stress, Cronin and Conboy, 2013), and disaster relief efforts (Cole and Yarberry, 2011; Yarberry, 2010).
Studies have shown that in combination with other interventions it can help reduce cravings, and improve the symptoms of depression, and anxiety, mood, headaches and body pains associated with substance withdrawal, as well as improve concentration and energy during the process (Carter et al, 2011; Stiyt et al, 2016)
Mechanisms of action:
Studies in humans and in animals have shown acupuncture to have measurable physiological effects on the brain, nervous system and neurotransmitters, including endogenous (the body’s naturally occurring) opiates (Lin et al, 2012). Studies have also demonstrated the relaxation and de-stressing effects acupuncture can provide from a physiological perspective, beyond placebo.
A recent, interesting paper (Lee et al, 2021): A review of neurobiological mechanisms of acupuncture for drug addiction. The authors examine the context from reward pursuit models, motivation, and the role of the mesolimbic dopamine pathway in drug sensitisation. They connect this to the way in which acupuncture can make neurochemical changes and influence dopamine levels via inhibition of neuronal and behavioural sensitization of the mesolimbic dopamine pathway. The neurotransmitter GABA is implicated along with endogenous opioids. A detailed paper, of interest to those who like a bit of research and technical explanation.
Case Study and Video for Trauma/PTSD
Acupuncturists (MBAcC) Rachel Peckham and Samina Haider set up an acupuncture NADA group in a Mosque in London in the aftermath of the Grenfell Tower tragedy, using the NADA protocol for trauma application, there is a video about this from the British Acupuncture Council here that may be of interest, and which shows the NADA protocol in action, and patients talking about it and their experiences of it: BAcC auricular (NADA) video Rachel talks about the general uses of this, background and the idea which came from the use of this in the aftermath of 9/11 in America.
Regarding Your Individual Condition and Symptoms:
Whilst the scientific studies are of great interest to researchers and acupuncturists in terms of comparing protocols, for the patient not versed in research they are less accessible, which is why when we asked “can acupuncture work for my (condition or symptom) we are not able to give a simple yes or no response, we are able to tell you in the decades of experience we personally have at the clinic of the types of outcomes we have seen in similar cases, and give you an idea of our level of experience and knowledge in that area, which is why the research data do not tell the whole story and if you want to find out more specific information in how this could relate to your own individual situation, we recommend booking a free telephone consultation where we can answer any questions you have and give a realistic appraisal of what acupuncture may be able to provide.
British Acupuncture Council evidence based factsheet about addictions and substance use including specific research, trials and mechanisms of action for acupuncture in this condition.
British Acupuncture Council Review Paper Substance abuse and acupuncture: the evidence for effectiveness
Carter, K.O., Olshan-Perlmutter, M., Norton, H.J. and Smith, M.O., 2011. NADA acupuncture prospective trial in patients with substance use disorders and seven common health symptoms. Medical Acupuncture, 23(3), pp.131-135.
Chen, J.A., Chen, J.A., Lee, S. and Mullin, G., 2018. Potential role for acupuncture in the treatment of food addiction and obesity. Acupuncture in Medicine, 36(1), pp.52-55.
Cole, B. and Yarberry, M., 2011. NADA training provides PTSD relief in Haiti. Deutsche Zeitschrift für Akupunktur, 54(1), pp.21-24.
Cronin, C. and Conboy, L., 2013. Using the NADA Protocol to Treat Combat Stress-Induced Insomnia: A Pilot Study. Journal of Chinese Medicine, (103).
Chen, Z., Wang, Y., Wang, R., Xie, J. and Ren, Y., 2018. Efficacy of acupuncture for treating opioid use disorder in adults: a systematic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine, 2018.
Chen, Z., Wang, R., Zhang, M., Wang, Y. and Ren, Y., 2020. Acupuncture combined with medication for opioid use disorder in adults: a protocol for systematic review and meta-analysis. BMJ open, 10(6), p.e034554.
Chen, Y., Zhang, L., Liu, Y., Yang, Y., Qiu, M., Wang, Y., Peng, W., Li, H. and Zhu, T., 2021. Acupuncture for Internet addiction: A protocol for systematic review. Medicine, 100(12), p.e24872.
D’alberto, A., 2004. Auricular acupuncture in the treatment of cocaine/crack abuse: a review of the efficacy, the use of the National Acupuncture Detoxification Association protocol, and the selection of sham points. Journal of Alternative & Complementary Medicine, 10(6), pp.985-1000.
Dai, R., Cao, Y., Zhang, H., Zhao, N., Ren, D., Jiang, X., Zheng, G., Bao, S., Yan, X. and Fan, J., 2021. Comparison between Acupuncture and Nicotine Replacement Therapies for Smoking Cessation Based on Randomized Controlled Trials: A Systematic Review and Bayesian Network Meta-Analysis. Evidence-Based Complementary and Alternative Medicine, 2021.
Fan, Arthur Yin, David W. Miller, Bonnie Bolash, Matthew Bauer, John McDonald, Sarah Faggert, Hongjian He et al. “Acupuncture’s role in solving the opioid epidemic: evidence, cost-effectiveness, and care availability for acupuncture as a primary, non-pharmacologic method for pain relief and management–white paper 2017.” Journal of integrative medicine 15, no. 6 (2017): 411-425.
Ge, S., Lan, J., Yi, Q., Wen, H., Lu, L. and Tang, C., 2020. Acupuncture for illicit drug withdrawal syndrome: A systematic review and meta-analysis. European Journal of Integrative Medicine, 35, p.101096.
Lee, S. and Jo, D.H., 2019. Acupuncture for reduction of opioid consumption in chronic pain: A systematic review and meta-analysis protocol. Medicine, 98(51).
Lee, M.Y., Lee, B.H., Kim, H.Y. and Yang, C.H., 2021. Bidirectional role of acupuncture in the treatment of drug addiction. Neuroscience & Biobehavioral Reviews, 126, pp.382-397.
Leung, L., Neufeld, T. and Marin, S., 2012. Effect of self-administered auricular acupressure on smoking cessation–a pilot study. BMC complementary and alternative medicine, 12(1), p.11.
Lin, J.G., Chan, Y.Y. and Chen, Y.H., 2012. Acupuncture for the treatment of opiate addiction. Evidence-Based Complementary and Alternative Medicine, 2012.
Liu, X., Qin, Z., Zhu, X., Yao, Q. and Liu, Z., 2018. Systematic review of acupuncture for the treatment of alcohol withdrawal syndrome. Acupuncture in Medicine, 36(5), pp.275-283.
Margolin, A., 2003. Acupuncture for substance abuse. Current psychiatry reports, 5(5), pp.333-339.
Stuyt, E.B. and Voyles, C.A., 2016. The National Acupuncture Detoxification Association protocol, auricular acupuncture to support patients with substance abuse and behavioral health disorders: current perspectives. Substance abuse and rehabilitation, 7, p.169.
Wang, J.H., van Haselen, R., Wang, M., Yang, G.L., Zhang, Z., Friedrich, M.E., Wang, L.Q., Zhou, Y.Q., Yin, M., Xiao, C.Y. and Duan, A.L., 2019. Acupuncture for smoking cessation: A systematic review and meta-analysis of 24 randomized controlled trials. Tobacco induced diseases, 17.
Yarberry, M., 2010. The Use of the NADA Protocol for PTSD in Kenya. Deutsche Zeitschrift für Akupunktur, 53(4), pp.6-11.
Zhang, T., He, X., Wu, L., Feng, X., Yang, Y. and Deng, L., 2021. Electro Acupuncture Combined Methadone for Withdrawal Symptoms of Opioid Addiction: A Protocol for Systematic Review and Meta Analysis. Acupuncture & Electro-Therapeutics Research.