Fifth Edition

Acupuncture
Detoxification
Specialist
Training Resource
Manual
A handbook for individuals training in the
National Acupuncture Detoxification Association’s
Five-needle Acudetox Protocol.
2017 National Acupuncture Detoxification Association
National Acupuncture Detoxification Association
P.O. Box 1066
Laramie, WY 82073
USA Toll Free Phone: (888) 765-NADA Outside USA (307) 460-2771
Fax: (573) 777-9956
Email: NADAoffice@acudetox.com
Web: www.acudetox.com

Key words: acudetox, acupuncture, detoxification, addictions, substance abuse, chemical dependency,
treatment, adjunct treatment, NADA, National Acupuncture Detoxification Association, community
health, behavioral health

© National Acupuncture Detoxification Association 2017

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or
transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise,
without the prior permission of the National Acupuncture Detoxification Association or one of its
designated agents.

NADA only authorizes its designated Registered Trainers to provide NADA ADS training and
considers the concepts and materials in this manual (unless duly attributed otherwise) to be the
intellectual property of NADA.

NADA gratefully acknowledges the many hands that contributed to this edition of our training manual.

Senior editors: Claudia Voyles, Rachel Toomim and Libby Stuyt

What is the National Acupuncture Detoxification Association?

PURPOSE: Understanding the principles of both Chinese medicine and chemical dependency can lead to significant benefit
in recovery from all forms of drug addiction as well as alcoholism and a variety of mental disorders. NADA protocols,
especially designed for this type of treatment, have been carefully developed and extensively tested. More than 500 clinical
sites in the US, Europe, Australia and the Caribbean currently utilize these protocols, even in settings where threats of
violence had previously made it difficult to serve clients. While adapted to Western attitudes and conditions, the NADA
method derives directly from Chinese medicine theory of detoxification. Our best hope for success is unified application of
these protocols, which NADA promotes through:

1. Public education about acupuncture as a recovery tool.

2. Training and certification of professionals in use of the technique.

3. Consultation with local organizations in setting up treatment sites.

4. Distribution of NADA-approved literature and a member newsletter.

"Nada," in Spanish, means "nothing." It signifies a drug-free, no-nonsense approach. Acupuncture detoxification is
inexpensive, drug-free and popular in most cultural circumstances. A clinic can be established in any location where people
being treated can sit in a group.

NADA is a catalyst for social development. After NADA comes in and provides training and consultation, the acupuncture
treatment programs are run by local agencies.

ORGANIZATION: NADA is a nonprofit organization which relies primarily on volunteers. Dues of $65 a year from
members go to pay for phone bills, office equipment, mailings, etc. NADA also tries, as possible, to provide scholarships to
its annual conferences.

CERTIFICATE OF COMPLETION: Clinicians who wish to receive a NADA Certificate of Completion must study
under a NADA Registered Trainer. As a means for professionals to become Acupuncture Detoxification Specialists
(ADSes) NADA offers a mixed didactic/clinical training for a minimum of 70 hours. NADA advocates a competency-based
approach based on a format of 30 hour classroom/didactic training course followed by 40 hours of hands-on work in a
clinic. Upon completion of training, an application is submitted to NADA for final approval. Those unable to meet the
competencies will be required to perform additional didactic/practicum work in order to attain their certificate, at the
discretion of the NADA Registered Trainer and/or NADA Training Committee. To find out more about obtaining as
Certificate of Completion, use the NADA contact information below.

TRAINING SITES: For health workers who have current or past qualified experience as professional clinicians, training in
the NADA protocol is available on an ongoing basis by trainers around the country.

To view available training opportunities check the training calendar on the NADA website: www.acudetox.com. To arrange
training at your site or somewhere in your region, call the NADA office below to be connected with a Registered Trainer.
You may also search for individual trainers’ contact information on our website’s Trainer Directory, a resource available to
the public.

MEMBERSHIP: For a membership application, or any other NADA business,

Email: NADAOffice@acudetox.com Website: www.acudetox.com
Telephone: (within the US) 888-765-NADA or 307/460-2771 (outside USA) Fax: 573/303-0111
or write to P.O. Box 1066, Laramie, WY 82073
Membership applications and other information may also be found at www.acudetox.com
Please take a few minutes to fill out this form. Your feedback will help your trainer and
NADA to improve the quality of NADA trainings.

Name _______________________________________
(optional)

Trainer(s) ____________________________________

____________________________________

Training Dates ________________________________

Needs Satisfactory Good Superior

1. Content of training. 1 2 3 4
Comments:

2. Trainer’s presentation, ability 1 2 3 4

to explain information, create a
learning environment.
Comments:

3. Trainer’s knowledge and experience 1 2 3 4

Comments:

4. Planning & organization of training. 1 2 3 4

Comments:

5. Trainer’s instruction & feedback 1 2 3 4

during clinical practice.
Comments:

6. Trainer’s attitude towards students 1 2 3 4

(respect,encouraging questions,
supportive)
Comments:
7. What were the trainer’s strengths in teaching this course?

8. What areas would you want the trainer to work on?

9. What parts of the training did you appreciate most?

10. What parts of the training would you change or omit and why?

11. Did this training meet your expectations? Are you satisfied with your experience?
Please explain.

12. Do you have any additional comments?

 CONFIDENTIAL – For the NADA office/Training Chairperson only
If you have any problems or issues concerning this training that you want to bring to the attention of
NADA or the Training Chairperson, you may describe them below, and send this form directly to the
NADA office. Please include your name and phone number so that we may follow up with you. This
information will be kept confidential.

National Acupuncture Detoxification Association

PO Box 1066 Laramie, WY 82073
Email: NADAoffice@acudetox.com Fax: 573-777-9956
Toll free: (888) 765-NADA (U.S. only) Outside the US: (307) 460-2771
www.acudetox.com
 NADA Training Application for the Acupuncture Detoxification Specialist (ADS)
Record of Training Completion

PLEASE PRINT or TYPE (online fillable form available at www.acudetox.com in the Member Center)
First Name M.I. Last Name

Organization (If applicable – please note if required for mailing address) Title and Job Position

Street Address or P. O. Box (please circle: Home / Work – this is where your Guidepoints newsletter will be mailed to)

City State/Province Zip / Postal Code Country

Day Phone Cell Phone Email (Required for website login)

Include fee with your Payment method (check or money order payable to NADA in US funds only):
application:
 Check  Money Order  Visa MasterCard Discover  AmEx
 Associate/ADS: $70. Credit/Debit Card # Exp. Date 3- or 4- digit code

 Student/Senior: $40.
(Registered Trainer verification Name on card Billing address if different than mailing address below
or student ID attached)

An ADS is an individual who has: (1) completed the NADA classroom training and clinical practicum, (2) signed the Ethics
Pledge, and (3) Received a signature from their Registered Trainer at the bottom of this form. An Associate is an individual
who participated in the classroom portion of the NADA training but has yet to complete the clinical practicum. Submitting
this form along with the correct fee entitles the applicant to a 1-year membership with NADA. Clinical practicum hours
must be completed within a year from the end of the classroom training.

(1) List relevant training/experience in Addictions/Behavioral Health, Medical and/or Eastern Medicine field(s):

________________________________________________________________________________________________________

(2) How are you planning to apply the NADA protocol training?

_________________________________________________________________________________________________________

(3) List your current professional credentials/licenses (if any)

_________________________________________________________________________________________________________
*Are you under any disciplinary action/restriction to your license/credential? Yes No
If yes, attach explanation. *A response to this question is required.

Applicant: I certify that all answers provided are true and complete to the best of my knowledge. I understand that giving
false information, misrepresenting facts, material omissions, any ethics breach or loss of license/certification currently or
during my career as an ADS may be grounds for denial of an ADS record of training or loss of ADS status.

Applicant Signature: _____________________________________________________ Date: _____________________

Note: The date of the Applicant Signature is the date when the classroom portion of the training has concluded.

*******************************************************************************************************************************
To be filled out by the NADA Registered Trainer:
Name of Registered Trainer (Please print in block letters or type):_________________________________________________________________

Registered Trainer Confirmation: I hereby confirm that this trainee has satisfactorily completed training as an Acupuncture Detoxification
Specialist. I recommend the record of training completion be issued.

Signature of Registered Trainer: _______________________________________________________ Date: _________________________

Note: The date next to the RT signature is the date used on the ADS’ record of training as their training completion date.

Return application materials to: Registered Trainer or

National Acupuncture Detoxification Association, PO Box 1066, Laramie, WY 82073 USA
(888) 765-NADA (307) 460-2771 Fax: (573) 303-0111 membership@acudetox.com
Rev. 07/19
 NADA Training Application for the Acupuncture Detoxification Specialist (ADS)
Record of Training Completion

Ethics Pledge for NADA Members and Acupuncture Detoxification Specialists (ADSes)
As an Acupuncture Detoxification Specialist, I pledge to:
1. Believe in the dignity and worth of all human beings and to provide service for the welfare and betterment of all those served by the
acudetox treatment, as endorsed by the National Acupuncture Detoxification Association (NADA);
2. Use acudetox in a supportive and nurturing way in the recognition of the right to humane treatment of suffering directly or indirectly
from alcohol and drug addiction and behavioral health issues in general;
3. Never withhold treatment as punishment or to use acudetox in a programmatically punitive manner;
4. Maintain a professional relationship with all persons served and to refer them to the appropriate service or practitioner promptly
when this is not possible;
5. Be committed to a drug-free, sober state for all patients whose primary reason for receiving acudetox is to support their recovery
from addictions;
6. Never to do anything that would weaken the physical or mental resistance of a human being, except for strictly therapeutic or
prophylactic indications imposed in the interest of the patient;
7. Refrain from undertaking any activity where my personal conduct, including the abuse of alcohol or drugs, is likely to result in inferior
professional services, denigrate the profession in general, or constitute a violation of law;
8. Adhere strictly to the established rules of confidentiality of all records, materials and knowledge concerning persons served in
accordance with all current government regulations including but not limited to HIPAA;
9. Not associate myself with commerce in such a way as to let it influence, or appear to influence, my attitude towards the treatment of
my patients;
10. Not exploit acudetox for personal gain;
11. Make an effort to keep fees within the reach of the general public and to offer sliding fee scales for those patients who require such
consideration;
12. At all times to maintain the highest standards in all the services I provide, valuing competency and integrity over expediency or
temporary success:
13. Support NADA’s mission and the organization, including the Registered Trainer-based training system and, when possible, give back
and maintain an active membership;
14. Provide accurate information regarding my education, training, experience, professional affiliations, certifications and licensure;
15. Not claim directly or by implication professional qualifications exceeding those that I have actually attained;
16. Recognize the limits of my ability, providing services only in those areas where my training and experience meet recognized
professional standards;
17. Accept the fact that training in the acudetox technique does not imply competency to use acupuncture in general unless so trained
and licensed;
18. Limit my practice of acupuncture to the NADA protocol unless I am a permitted to perform acupuncture in general under the scope of
practice of my professional licensure;
19. Regularly evaluate my own professional strengths and limitations, biases and levels of effectiveness and to strive for self-
improvement by seeking professional development through further education and training. When appropriate, I agree to have my
technical competencies reviewed by a NADA designated consultant and/or Registered Trainer;
20. Practice acudetox in accordance with state, provincial and/or local regulations where such exist;
21. Seek supervision as needed and as required by state, provincial and/or local regulations;
22. Respect the integrity of other forms of health care and to make efforts to build bridges and develop collaborative relationships to
achieve the best possible care for individual patients;
23. Use acudetox in conjunction with appropriate counseling and supportive services;
24. To contribute my ideas and finding to the general body of knowledge concerning acudetox and acupuncture for behavioral health
issues;
25. Make public statements regarding the effectiveness of acudetox that are within the generally accepted experience of the profession
as a whole or within the individual practitioner’s experience;
26. Use great caution in publishing discoveries and methods of treatment whose value is not yet recognized by the profession at large;
and
27. Always recognize that I have assumed a serious social and professional responsibility due to the intimate nature of my work that
significantly touches upon the lives of other human beings.

By my signature below I agree to uphold the foregoing pledge:

Signature: ____________________________________________ Printed Name: ____________________________________ Date: _____________

Return application materials to: Registered Trainer or

National Acupuncture Detoxification Association, PO Box 1066, Laramie, WY 82073 USA
(888) 765-NADA (307) 460-2771 Fax: (573) 303-0111 membership@acudetox.com
Rev. 07/19
Date filled out: ______________
NADA Program Survey 
Program Name: 

Address:  City:  State:  Zip: 

Program Phone:                                                                 Program Website: 

Primary Contact Name:  Primary Contact Title/Job Position: 

Primary Contact Phone:  Primary Contact Email: 
Secondary Contact Name:  
Secondary Contact Title/Job Position: 
(if applicable) 
Secondary Contact Phone:  Secondary Contact Email:  

Best Way to Contact:                Call Program               Call Contact                Email Contact  
Program offers NADA at other locations?  YES  NO  
If YES, other locations:  
NADA service open to:    Public   Clients   Both 
If clients only, can they access NADA after discharge?            YES           NO 
Is payment required for NADA services?  YES   NO 
What is the fee for NADA treatments?  Sliding Scale?   YES    NO 
Walk‐ins accepted for NADA treatments:  YES  NO  Appointments:   YES  NO 
How is NADA offered?  Groups  Individuals         Both 
Screening/Admission/Intake/Consent required?  YES  NO 
When are NADA treatments available? (i.e. scheduled times, by appointment, only Mondays, etc.)  

 
SETTING: Please indicate the setting(s) where acudetox is available through the program 
Drug Court   Mental Health Court  Veterans Court  Homeless Shelter 
Jail  Hospital  Community Clinic  Drop‐in Center 
Prison  College/University Campus  Veterans Administartion   Transitional Living Program 
Harm Reduction   Bus/Mobile Services  Military Hospital  Other Community Center 
Halfway House  Church   Other Military Setting  Other (please specify):  
 
 
POPULATION: Please indicate what sort of population(s) are recieveing acudetox services through the program 
Children   Youth (13 & older)  Adults (18‐65)  Elderly (66 & older) 
Families  Female only  Male only  Maternal 
LGBTQ  Native American   Minorities  Immigrants 
Active Duty  Veterans  Low‐income  Homeless 
Military 
Living with  Living with Sickle‐Cell   Living with Cancer  Living with HIV/AIDS  
disabilities  Anemia   
General   Other (please specify):  
Community  
 

 
 NADA Program Survey 
Please mark any treatment services available through the program, if applicable:  
TREATMENT  Inpatient  Outpatient  Therapeutic  12 Step  Individual  Group  Full Body 
SERVICES:  Groups  Groups  Counseling  Counseling  Acupuncture 
Drug Addiction               
Alcoholism               
Dual Diagnosis               
Methadone               
Suboxone               
Smoking Cessation               
Trauma Recovery               
Psychiatric Care               
Integrative Health               
 

Are any other services offered? Please describe: 
 
 
How does this program receive funding? 
 
If you are paid to provide NADA services, how are you compensated? 
  Employed  Contracted  Volunteer (unpaid) 
Who pays for the acudetox supplies? (needles, swabs, sharps container, etc.) 
        Program         Client Donations                    Practitioner                                    Other: 

Acudetox Providers:          Social Workers             Nurses                  Counselors                      Community Health Workers   
P   Peer Recovery Workers                Medical Doctors                    Licensed Acupuncturists                     Health Promoters 

Acudetox Supervisors:           Licensed Acupuncturist                    Medical Doctor                                 Acudetox Specialist   
S   Supervision is determined by license of provider                   Administrator or clinical supervisor within the program 

Average # of acudetox treatments provided per week: 

Average # of individuals in one group setting: 

Is Sleepmix Tea offered?  YES   NO 

Have you encountered any barriers in providing NADA services?  
 
 

Is there anything else you would like us to know about this program or the NADA services provided? 
 
 
 
What do you think are some projects NADA could be doing? 
 
 

     
 Consent to NADA Acudetox Treatment

Treatment Description
Acudetox is a specialized form of acupuncture and is performed by placing five thin, sterile, single-use
needles in your ears. The needles are generally left in place for 35 – 45 minutes. Treatment time may need to be
altered for clinical or training purposes. State Licensed Acupuncturists, Licensed Auricular Detoxification
Specialists (ADSes) and/or others persons training to become Auricular Detoxification Specialists (ADS
Trainees) administer the treatments.
Voluntary
I hereby voluntarily consent to be treated by acupuncture, and in particular the NADA acudetox protocol. I
understand I may be treated with needles and/or small seeds taped to my ears.
I have not been guaranteed any success concerning the uses and effects of acudetox. I understand I am free
to discontinue treatment at any time.
Possible Side Effects/Healing Reactions
I understand that acupuncture may result in certain side effects, including local bruising, slight bleeding,
fainting, temporary pain and discomfort, and temporary aggravation of symptoms existing prior to treatment.
Conventional medical therapy also may be indicated, either in response to an emergency or as deemed necessary
at the discretion of a licensed physician.
Medical Referral
I understand if there is a worsening of my ailment or condition or if a new ailment or condition arises, that I
should consult a licensed physician. I also understand that if I am currently under a physician’s care I should
continue as long as my physician and I deem it necessary and that my acudetox providers do not recommend
altering medications or other therapies without first consulting my personal physician or provider.
Infectious Disease/Clean Needle Procedures
I understand that infectious diseases may be carried through the air, through physical contact, and through
body fluids. I understand that acudetox practitioners/trainees follow the prescribed national standards of
Universal Precautions to guard against the spread of infection through the use of sterilized, prepackaged,
disposable single-use needles.
I further understand that I am responsible for cleaning my ears prior to acudetox treatment.

___________________________________ __________________________________
Name (Printed) Signature

___________________________________
Date
 National Acupuncture Detoxification Association
Acudetox Specialist Training Resource Manual
Table of Contents

Section Title Page #

Introduction to the NADA ADS Training Resource Manual Introduction 1 – 6
Section I 7 – 20
The NADA Acudetox Protocol
– Auricular Acupuncture for Addictions and Behavioral Health
History
The NADA Protocol
Acudetox-based Treatment Model

Section II A 21 – 38
Learning the NADA Protocol
Point Descriptions and Locations
Technique Mastery
Trial Treatments and Clinical Experience
Ear Seeds/Beads
Sleep-Mix Tea

Section II B 39 – 48
Learning the NADA Protocol
Partnership with Clients
Communal Treatment Approach / Effect
Boundaries and Self Care
Creating the Atmosphere
Informed Consent and Client Information
Documentation

Section III 49 – 56
Public Health and Regulatory Concerns
Exposure Control / Safety
NADA Clean Needle Technique

Section IV 57 – 60
Research and Acudetox
Section V 61 – 82
Integration and Sustainability
Applications and Outcomes
Integration with the Treatment Milieu
Integration at a Systems Level
The Acupuncture Interface
Acupuncture as Innervention
Program Sustainability

Section VI 83 – 88
Oriental Medicine in the Context of
Addictions and Behavioral Health and Treatment
Introduction to Oriental Medical Concepts
Oriental Medicine as Related to Behavioral Health and Recovery
“Empty Fire”

Section VII 89 – 102

Client Management Issues and Strategies
Special Populations: Understanding Needs and the Role of Acudetox

Section VIII 103 – 114

Use of NADA in Trauma/Disaster/Crisis Relief
Neurobiological Effects of Trauma
Treating Trauma/Preventing PTSD

Section IX 115 - 122

Ethical and Legal Issues

ADS Pledge
Confidentiality / HIPAA
Consent to Treatment
Compliance with All Federal, State and Local Regulations
Supervision

Section X 123 – 133

The Nature of Addiction and Recovery

Models for Understanding Addictions and Behavioral
Health and Recovery
Treatment Models
Pharmacology of Psychoactive Substances

Section XI 134 – 225

Appendices
A. The Lincoln Story
B. Sample Client Information and Forms
C. Acudetox Risk Management
D. Research
E. Excerpts from Treatment Improvement Protocol (TIP) 45
F. Special Populations
G. Sample Program Forms
H. Selected Monographs on Addiction and Recovery
I. Supplies, Vendors and Publications
J. References
National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Introduction 1
Introduction to NADA and Acupuncture Detoxification Specialist Training

Welcome to the National Acupuncture Detoxification Association (NADA) and this

Acupuncture Detoxification Specialist (ADS) Training Manual. Facilitating training in the
acudetox protocol was a key goal during the formation of NADA and it remains one of the
primary objectives of the organization today.

The training follows a curriculum adopted by NADA for the use of acupuncture in the fields of
addictions and behavioral health. The competency-based training involves both didactic and
clinical experience and is open to acupuncturists, physicians, nurses, psychologists, counselors,
social workers, and other appropriate individuals as allowed by local regulations. The training
emphasizes a clinical apprenticeship because coping with individual distractions and group
process is of great importance and more difficult than the technical skill of repetitive needle
insertion. ADS training is delivered by NADA designated Registered Trainers and represents an
interactive learning process. A Certificate of Training Completion is granted by NADA to those
individuals who successfully complete all of the training requirements and demonstrate the
competencies outlined below.
The National Acupuncture Detoxification Association Mission Statement
The National Acupuncture Detoxification Association is an educational, not for profit, tax-
exempt corporation supporting education and training in a specific auricular acupuncture
protocol integrated with comprehensive addictions and behavioral health treatment programs to
relieve suffering during detoxification, prevent relapse and support recovery. NADA strives to
make acudetox-based, barrier free addictions and behavioral health treatment accessible to all
communities and to ensure its integration with other treatment modalities.

The NADA mission exists to utilize the principles of both Oriental medicine and Western
addictions and behavioral health models to bring significant benefit to persons in recovery from
addictions and a variety of mental disorders. The NADA protocol, a simplified, standardized ear-
needling technique, derived from acupuncture specifically for this type of treatment, has been
carefully developed and extensively tested.
The word “nada” means “nothing” in Spanish. It signifies an abstinence-oriented, no-nonsense
approach. (However, can be used in conjunction with almost any existing type of addiction
and/or behavioral health therapy.) Nothingness is also one of the key tenants of Taoist
philosophy. For example, it is said in the Tao Te Ching, that while a vessel is made from a lump
of clay, it is the emptiness inside that makes it useful. This concept correlates well with the
Alcoholics Anonymous (AA) principle of keeping life simple.
The NADA Organization
NADA is an organization of individuals who support the use of a five-point auricular
acupuncture protocol – acudetox – in addictions and behavioral health treatment settings to
alleviate suffering and to support recovery.

NADA was founded and incorporated in 1985 as a professional and educational organization. As
such, it has overseen the rapid spread of the NADA acudetox protocol into an ever-expanding
National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Introduction 2
number of addictions and behavioral health treatment settings. Within these settings, acudetox
has been shown to increase client retention and improve client outcomes.

A diverse and dedicated Board of Directors guides NADA, with over 10,000 associates and
trained practitioners worldwide. More than 1500 clinical sites in the US, Canada, Europe, Asia,
Africa, Australia, Latin America and the Caribbean currently use this protocol.
NADA is committed to:
 Providing training to a broad range of health care professionals and other qualified
persons. If ADS trainings and practice were restricted to licensed acupuncturists and
physicians, very few treatments would be done and a great resource would be lost.
 Assuring professional standards and ethical application in the use of this modality, while
striving toward increased access by those needing treatment. NADA-style acudetox is
not a stand-alone intervention, but best combined with other addictions and behavioral
health treatment modalities that meet the standards of the field.
 Assuring that the principles of Oriental medicine and behavioral health and addictions
treatment are integrated together in training and treatment/ application.
 Maintaining a public service approach in ameliorating the plague of addictions that
constitutes one of the most serious threats to the physical and social well being of society.
Program Development
NADA provides access to materials and consultation regarding implementing an acudetox-based
treatment program. Available topics of consultation also include treating diverse populations,
acupuncture for addictions research, criminal justice diversion programs, etc.
Education
Besides publishing its own newsletter, Guidepoints, NADA maintains a literature clearinghouse
that offers hundreds of articles, tapes and videos on a range of related topics such as program
development, treatment of special populations, trauma treatment, etc. Its national office arranges
local, regional or national workshops, demonstrations and NADA acudetox training courses and
coordinates a speakers’ bureau of experts in the addictions, behavioral health and acupuncture
fields. Curriculum development support for acupuncture schools, universities and addictions
courses is also provided.

The Association hosts an annual national conference for professional education, updates and
sharing that offers CEU’s for acupuncturists and alcohol and drug addictions counselors. NADA
participates in many national and international forums as well.
On the Terminology Used Throughout This Manual
Several different terms are used within the field for which the NADA acudetox protocol is
generally used and often these terms are used interchangeably. For this purposes of the manual,
the word addictions is the overarching term used to characterize the behavioral, physiological
and psycho-spiritual aspects of this disease. Specific addictions to substances or behaviors are
all included under this umbrella term. Another overarching term, behavioral health, is also used
throughout this manual and refers to mental health conditions and treatment including but not
limited to addictions.
National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Introduction 3
Throughout the evolution of NADA, the term for its style of ear acupuncture treatment has gone
through several iterations. acu detox, acu-detox, acudetox and other spellings have all been used
at one time or another and will most likely continue to be used. In this manual, the spelling
acudetox is used throughout to indicate this treatment modality.
NADA Acudetox Treatment
NADA-style treatment incorporates frequent acudetox sessions, an herbal tea blend and the use
of ear seeds and/or magnetic beads all within the context of addictions and behavioral health
treatment and prevention programs and mutual support fellowships.
Acudetox involves the gentle placement of five small, sterilized, disposable stainless steel
needles in specific sites on each ear of a client undergoing treatment. The recipients sit quietly in
a group setting for 30 - 45 minutes.
Acupuncture Detoxification Specialist (ADS) Training
The ADS concept
The NADA acudetox protocol is a simple, non-diagnostic modality that is readily taught to front-
line treatment providers and is appropriate for behavioral health clientele. Many states in the US
(including New York, Maryland, Virginia, Texas, Arizona and more than 20 others), Canadian
provinces, and countries in Europe, Asia, Africa, Australia and South America have provisions
for allowing non-acupuncturist ADSes to apply the acudetox protocol to addictions and/or
behavioral health clients, generally under supervision of a licensed acupuncturist or physician.
This forward thinking concept allows a much greater number of addictions and behavioral health
clients to benefit from the acudetox modality than would otherwise be possible if the treatment
were restricted to only licensed acupuncturists or physicians. Few addictions and behavioral
health treatment programs can afford to hire licensed acupuncturists to do direct care. Allowing
in-house addictions experts to offer acudetox also greatly enhances treatment relationships.

While licensed acupuncturists and other healthcare providers whose professional scope of
practice allows them to perform acupuncture can legally needle the five acudetox points without
NADA training, NADA strongly recommends that all practitioners planning to provide acudetox
be educated through the specialized NADA training. Understanding concepts and philosophies
outlined in the training is vital to successful outcomes with this modality. Additionally, in
jurisdictions where supervision of non-acupuncturist ADSes is required, the supervising
acupuncturist or physician is often required to be NADA trained.
Purpose of training
It is NADA's privilege and responsibility to prepare well-qualified practitioners who can
demonstrate the skills of acudetox. NADA developed and maintains a specialized training
protocol to:
1. define the scope of practice of the Acupuncture Detoxification Specialist (ADS) for
rendering services for addictions and behavioral health treatment through the provision of
an adjunct auricular acupuncture intervention;
2. promote the NADA client centered treatment approach: always respecting the dignity of
the individual and the importance of developing the internal foundation for recovery;
National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Introduction 4
3. address the public need for safe, accessible addictions and behavioral health treatment
services by facilitating the appropriate training of ADSes and thereby expanding the
availability of auricular acupuncture in those settings;
4. define basic competencies in order to assure minimum standards of acceptable
preparation and practice;
5. establish a core curriculum that serves as criteria for fundamental and consistent training
of ADSes.
Scope of practice
The title "Acupuncture Detoxification Specialist" (ADS) denotes one who is trained specifically
in integrating the NADA acudetox auricular acupuncture protocol into addictions and behavioral
health treatment and prevention (which may also be referred to as detoxification, chemical
dependency treatment, dual-diagnosis, or substance abuse treatment.)

Licensed acupuncturists or those healthcare practitioners permitted to perform acupuncture under

the scope of practice of their professional licenses or certifications are generally permitted to
administer acudetox in any setting to any type of client.

The scope of conditions that non-acupuncturist ADSes may treat is limited to those that are
related to addictions and behavioral health treatment, including detoxification, withdrawal,
emotional trauma, craving, stress syndromes, relapse prevention, rehabilitation and recovery
maintenance. This may include persons with coexisting chronic mental illness, HIV/AIDS,
PTSD or persons at risk for substance abuse. Non-acupuncturist ADSes shall provide acudetox
under the appropriate supervision and settings in compliance with local and/or state guidelines.
Eligibility for NADA ADS training
Individuals who work or intend to work within the addictions and behavioral health treatment
fields are eligible for ADS training. One of the benefits of the NADA protocol lies in the
simplicity and accessibility of its practice for a wide array of individuals, including but not
limited to counselors, physicians, physician assistants, nurses, acupuncturists, social workers,
detox technicians, psychologists, administrators, outreach workers, criminal justice workers,
recovery readiness/harm reduction workers, case managers etc. The protocol can be safely and
accurately integrated into a treatment milieu by a broad range of individuals with different roles
and responsibilities within their respective organizations. Candidates with little or no prior
experience may require additional training hours.

The practice of acudetox is generally regulated by state agencies and it is up to the individual to
ascertain whether it is legal for non-acupuncturist ADSes to perform the acudetox technique in
his or her jurisdiction. Furthermore, it is up to the individual ADS or ADS trainee to insure that
he or she remains in compliance with local regulations.
National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Introduction 5
Obtaining a Training Completion Certificate
Every trainee must complete the combined didactic and clinical experience provided and/or
overseen by a NADA Registered Trainer. In addition, he or she will demonstrate to the
satisfaction of that Registered Trainer a mastery of the basic competencies listed below.

Upon successful completion of all requirements (hours and competencies) and an application
process, the ADS will receive a Certificate of Training as an Acupuncture Detoxification
Specialist.

Occasionally applicants are not able to demonstrate the required competencies even upon
completion of the required hours of training. Such applicants will not be eligible to receive a
certificate until they do so. Individuals may work with a Registered Trainer to identify deficits
and in partnership create a plan that will allow the individuals to achieve appropriate mastery of
the materials and techniques.

PLEASE NOTE: The Training Completion Certificate indicates successful completion of NADA
training and demonstration of entry-level skills. NADA does not provide initial or ongoing
certification of ADSes. ADSes are encouraged to maintain competencies and continue to expand
their knowledge by pursing continuing education, attending the NADA annual conferences and
maintaining active annual membership in the organization.

ADSes each sign an Ethics Pledge verifying the understanding of and agreeing to abide by rules
regarding limited scope of practice as appropriate, confidentiality, client rapport and respectful
treatment, financial interest, and sharing experiences with the NADA community.
NADA asks that each trainee join the organization. Affiliation, good for one year, entitles
trainees to numerous benefits, including the newsletter.
Upon successfully completing training requirements and demonstrating mastery, the trainee
submits to the NADA office an application for a training completion certificate, signed by the
Registered Trainer, and a signed ethics pledge.
National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Introduction 6
ADS standards of competency
1. Able to perform at least 20 treatments during a 4-hour period with good point
location and technique.
2. Able to explain the uses and limitations of the treatment.
3. Able to demonstrate sensitivity, compassion and respect for clients.
4. Able to understand the communal treatment effect and maintain an
appropriate atmosphere.
5. Able to demonstrate clean needle technique.
6. Able to demonstrate familiarity with research and outcome results of NADA
programs.
7. Able to demonstrate understanding of and to comply with, the limited scope
of practice and other ethical principles.
8. Able to demonstrate understanding of the implications of role of auricular
acupuncture for addictions and behavioral health in the larger treatment
context.
9. Able to write chart notes re: status, treatment given and client response.
10. Able to demonstrate understanding of the adjunctive nature of acudetox and
the importance of collaboration and communication with the treatment team.
11. Able to demonstrate recognition of the psycho-spiritual nature of recovery and
respect and support the client's internal process.
12. Able to modify treatment appropriately (e.g., fewer needles, shorter retention)
and to respond to adverse clinical situations should they occur.
13. Able to demonstrate understanding of addictions and the NADA protocol
from the perspective of basic concepts of Oriental medicine (Qi, yin/yang,
empty fire).

These competencies are considered the minimum skills that must be demonstrated to
become an Acupuncture Detoxification Specialist. The trainee will further develop each
of these skills as she or he begins to apply the training in a treatment setting. This is true
whether the competency is the speed of inserting needles or achieving a greater level of
sensitivity towards clients. NADA reserves the right to deny a Training Completion
Certificate to anyone who, in the opinion of NADA and/or his or her Registered
Trainer(s), does not fully demonstrate these minimum skills.
National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Section I: Acudetox 7

Auricular Acupuncture for Addictions and

Behavioral Health Treatment

History
The NADA Treatment Protocol
NADA Acudetox-Based Treatment model
National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Section I: Acudetox 8
National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Section I: Acudetox 9
Lincoln Recovery Center History & Protocol

Acupuncture treatment for drug and alcohol problems was primarily developed at Lincoln
Hospital, a city owned facility in the impoverished South Bronx. The Substance Abuse Division at
Lincoln is a State licensed treatment program that has provided more than 500,000 acupuncture
treatments in the past 30 years. Yoshiaki Omura was the consultant who began the program
(Omura 1975). Initially, in 1974, Lincoln used H.L.Wen, MD's method. In the process of
researching the effects of applying electrical stimulation to the lung point in the ear for post
surgical pain, Wen discovered serendipitously that the acupuncture relieved opiate withdrawal
symptoms (Wen 1973).

When acupuncture was first introduced, Lincoln was a methadone detoxification program;
therefore, acupuncture was initially used as an adjunctive treatment for prolonged withdrawal
symptoms after a 10-day methadone detoxification cycle. Clients reported less malaise and better
relaxation. Subsequently, twice daily acupuncture was added concurrently with tapering
methadone doses. Reduction in opiate withdrawal symptoms and prolonged program retention
were noted.

It was accidentally discovered that electrical stimulation was not necessary to produce
symptomatic relief. In fact, simple manual needling produced a more prolonged effect. Clients
were able to use acupuncture only once a day and still experience a suppression of their
withdrawal symptoms. A reduction in craving for alcohol and heroin was described for the first
time. This observation corresponds to the general rule in acupuncture that strong stimulation has
primarily a symptom-suppression or "sedation" effect and that more gentle stimulation has more of
a long term, preventative or "tonification" effect.

The ear acupuncture protocol was expanded by adding "Shen men" (spirit gate), a point well
known for promoting relaxation. Other ear points were tried on the basis of lower resistance, pain
sensitivity, and clinical indication during a several year developmental process. Michael O. Smith
MD, DAc added the "Sympathetic", "Kidney" and "Liver" points to create a basic five-point
formula. Numerous other point formulas using body acupuncture points were tried on an
individual basis without any significant improvement. Smith also developed a companion herbal
formula known as "Sleepmix tea".

In 1978, the clinic relocated and discontinued the use of methadone as a part of its detoxification
protocol. Over the ensuing years Lincoln further developed a client-centered acupuncture-assisted
model of treatment. It became clear during the crack cocaine epidemic in the mid-1980's that the 5
point protocol was effective in assisting crack addicted persons to become and remain clean.

Lincoln also functions as the largest training institute for Acupuncture Detoxification Specialists.
Some 2000 ADSes from around the world were trained in this protocol at Lincoln, about 10
trainees per week.

In 1997, the Lincoln Medical and Mental Health Center changed its name to Lincoln Recovery
Center. Current services there include a comprehensive Maternal Substance Abuse Services
(MSAS) program for women who are pregnant or referred by the local children's services
administration and a Criminal Justice/General Detoxification Unit for both voluntary and
National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Section I: Acudetox 10
adjudicated clients. A Drug Abuse Information System component operates the on-site urinalysis
equipment linked to the clinic's computer system. Daily objective testing enhances treatment.

The Lincoln Hospital model can be summarized and defined as follows:

 ADS clinicians use three to five ear acupuncture points: Sympathetic, Shen Men,
Kidney, Liver and Lung.
 Treatment is provided in a group setting for a duration of 40-45 minutes. Treatment is
available without appointment Monday through Friday.
 Acudetox treatment is integrated with conventional elements of psychosocial
rehabilitation.
 Several other components of the Lincoln program are ideally combined with
acupuncture and represent the NADA treatment model. These items include:
o a supportive non-confrontational approach to individual counseling;
o an emphasis on Narcotics Anonymous and other 12 step activities early in the
treatment process;
o a lack of screening for "appropriate" patients;
o the use of herbal "Sleepmix" tea;
o the use of frequent toxicologies;
o a willingness to work with court-related agencies;
o a tolerant informal family-like atmosphere.

Lincoln Recovery Center closed as a NADA training facility in December 2010. Dr. Michael
Smith retired as Medical Director and will continue to work nationally and internationally to
promote the NADA mission through training, outreach, and consultation support.
National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Section I: Acudetox 11
Historical Highlights of Utilizing Acupuncture in the Behavioral Health Arena
 1971: New York Times senior editor James Reston published his account of his
appendectomy in Beijing that utilized acupuncture as an analgesic.
 1972: Wen, Hsiang-Lai in Hong Kong discovered by chance that needles inserted in the
ear – intended to be used as a preoperative anesthetic – abated physical withdrawal symptoms
from opium.
 1973: Wen and Cheung publish their results of treating 40 heroin and opium addicts with
electropotentiated ear acupuncture in the Asian Journal of Medicine. The New York Times also
ran an article on these findings including this quote from Wen, “We don’t claim it’s a cure for
drug addiction. If we can treat the withdrawal symptoms, make the patient more comfortable,
and alleviate their suffering, then we have achieved something. Our treatment is not the
complete answer to drug addiction.”
 1974: Lincoln Hospital Detox Program, Bronx NY, an outpatient methadone clinic since
1970 began using the Wen protocol. Michael O. Smith, MD a psychiatrist and medical
director of Lincoln Detox Program began working with the acupuncture clinic.
 1982: Smith, et al, published an article in The American Journal of Acupuncture
describing the five ear points used in their work as well as points in the hands and feet for
particular symptoms.
 1985: The National Acupuncture Detoxification Association (NADA) is founded and
incorporated by Michael Smith, MD and others to promote education and training of chemical
dependency clinicians in the NADA ear acupuncture protocol. The term acudetox is given to
this treatment.
 1986: Fr. Thomas Edward Gafney, SJ established NADA-style program in Katmandu. As
its first organizational activity, NADA conducted trainings at the Crow Agency and Pine Ridge
Indian reservations.
 1987: Bulluck, Culliton and Olander published research indicating the effectiveness of
acupuncture in treating chronic addiction (see Appendix “D 1”). Portland Addictions
Acupuncture Center established by David Eisen, LAc in Portland Oregon.
 1989: Acudetox program initiated for jailed drug-offenders in Miami. This was followed
shortly after by the opening of the Miami Drug Court with the Hon. Stanley Goldstein sitting
on the bench. The State of New York adopted the first statute to allow non-acupuncturist
ADSes to perform the acudetox technique.
 1991: NADA held its first large-scale conference in Santa Barbara, CA. NADA-UK
formed by John Tindell and Margaret Pinnington. First NADA Europe meeting held in
Sweden with representatives attending from The United Kingdom, Germany, UK, Finland,
Hungary, Russia and Sweden.
 1993: The charter issue of Guidepoints was published. An acudetox program was
inaugurated at the Bronx Psychiatric Hospital. The first National Drug Court Conference was
held in Miami.
 1994: The Oregon Gambling Treatment Program initiated an acudetox program. Alex
Brumbaugh published Transformation and Recovery. 8th Special Report to Congress on
National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Section I: Acudetox 12
Alcohol and Health mentioned acupuncture as a potential treatment modality. NADA issued its
first training manual.
 1995: NADA issued its initial list of 34 Registered Trainers. Ellinor Mitchell published
Fighting Drub Abuse with Acupuncture (now out of print). NADA-UK began training
“substance misuse teams” in Her Majesties Prisons, which resulted almost immediately in an
80% reduction of violent acts. Michael Smith, MD received first National Leadership Award
from the National Association of Drug Court Professionals.
 1996: Treatment Improvement Protocol Series 19 (TIP 19) published by the Center for
Substance Abuse Treatment (CSAT) of The National Institutes of Health gave modest support
for the use of acupuncture in opiate detoxification. GMHC released Points to Change video,
which became a staple of NADA trainings. The first acudetox web page went online.
 1997: The National Institutes of Health published Acupuncture. NIH Consensus Statement
that includes the conclusion, “There are other situations such as addiction, in which
acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included
in a comprehensive management program.”
 1998: Encyclopedia Britannica Medical and Health Annual published an article on
acudetox authored by Michael O Smith, MD. The “Lessons Learned” series of essays by
Claudia Voyles, LAc began appearing in Guidepoints.
 1999: The Journal of Substance Abuse Treatment published an article by Schwartz, et al,
on the value of acupuncture in substance abuse treatment (see Appendix “D 2”).
 2000: The New York State Office of Mental Health formally added acudetox standards to
state regulations. Jim Byrne, a volunteer from Lincoln Recovery, began NADA Ireland.
 2001: Acudetox training capability established in India and Thailand for Burmese refugee
camps. After the terrorist attacks on the World Trade Center, an acudetox for terrorism
survivors program began in Manhattan providing over 1,000 treatments in the first 10 days and
continued through 2007.
 2002: Pan-African Projects brought NADA treatments to Uganda and surrounding
regions. Transformation and Recovery had its second printing. The first methodologically
sound NADA treatment report on smoking cessation with positive results appeared in
American Journal of Public Health. The US Government reported 736 certified addictions
treatment programs in the US offered acupuncture. Members of NADA Italy completed a
study of smoking cessation.
 2003: Substance Misuse Program in UK expanded to over 130 correctional facilities.
NADA-style treatments in a residential program for street children in Peru expanded. Similar
programs in Mexico City and Philippines also expanded services. Homeward Bound, Inc
becomes a Training Center for NADA. This training center closed in 2010.
 2005: NADA members aided in Gulf Coast recovery efforts after hurricanes Katrina and
Rita and in Kashmir following earthquakes. In Israel, NADA-style treatments expanded into
several clinical institutions. Chiclayo Peru and Tijuana Mexico have formal training In
Medical Schools/ Universities for MD, Ph. D, and RNs’
National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Section I: Acudetox 13
 2006: CSAT updated TIP 19 with TIP 45, which contains several sections discussing the
use of acupuncture in detoxification and substance abuse treatment (See Appendix “E”).
National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Section I: Acudetox 14
National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Section I: Acudetox 15
 The NADA Acudetox Treatment
Acudetox involves a simple, standardized five-point auricular (ear) acupuncture modality. NADA-
style treatment incorporates frequent acudetox sessions, an herbal tea blend and the use of ear
seeds and/or magnetic beads all within the context of addictions and behavioral health treatment
and prevention programs and mutual support fellowships. Acudetox supports the treatment and
recovery process by making the client stronger from the inside.

 Acudetox involves the gentle placement of five small, sterilized, disposable stainless steel
needles in specific sites on each ear of a client undergoing treatment.
 The recipients sit quietly in a group setting for 30 - 45 minutes.
 Treatment is offered frequently, even daily if possible initially.
 The treatment is a non-verbal process with minimal interaction between client and
provider.
 The treatment benefit is immediate, tangible and apparent even to someone entering the
treatment center for the first time, and can be provided as an initial treatment intervention
before clients have developed a relationship with the counseling staff.
 Acudetox can be offered prior to an extended process of assessment and diagnosis.
 Acudetox has been shown to significantly decrease cravings for alcohol and drugs,
withdrawal symptoms, relapse episodes, anxiety, insomnia and agitation.
 Acudetox often helps participants become relaxed and more comfortable with their own
thoughts, enabling them to experience a sense of “letting go” of tensions and
apprehensions, and supporting quiet participation in a group setting with others who are
involved in the process of recovery.
 Acudetox facilitates relationships with self and others.
 Acudetox is effective regardless of the client’s level of motivation and tends to increase the
client’s readiness and willingness to participate in treatment.
 Acudetox improves the effectiveness of other program components.
 Acupuncture needles don’t put anything into the client; rather they remind the client of
what he or she already has.
 Acudetox opens up possibilities on the body, mind and spirit levels.
National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Section I: Acudetox 16
Unique Benefits of Using Acudetox in Behavioral Health Settings

Effective across types of addictions

 Outcome and anecdotal clinical reports indicate effectiveness with the commonly used
addictive substances and combinations of substances, and with behavioral/process
addictions such as gambling and sex addiction. Other interventions often target only
specific drugs.

Effective throughout the treatment/recovery process

 Originally developed for detoxification, the NADA protocol has since shown efficacy
when used in pre-treatment/harm reduction settings, throughout the stages of treatment and
as a relapse prevention and support for ongoing long-term recovery.
 It is consistent with 12-step recovery and other mutual support fellowships.
Effective along the continuum of care
 It has successfully been integrated with a wide range of addiction treatment models
including those utilizing medications.
Accessible to men, women and adolescents. Accessible cross-culturally.
Treats the whole person – body, mind, spirit, and emotions – just as addiction impairs the whole
person. It has a comprehensive, not compartmentalizing effect.
Non-verbal and non-performance (while most other treatment interventions are both).
Elicits immediate and long-term effects
 With the exceptions of medications administered, few treatment processes yield immediate
relief of suffering. Most promise future improvement.
Few complications and adverse reactions. Non-addictive.
Simple and flexible and inexpensive. Easily integrated into treatment settings.
Improves treatment relationships and the treatment environment. Relieves staff stress.
Improves treatment engagement, retention, and outcomes. AMA/APA rates decrease and
successful completion rates increase.
Paradoxically even more effective with the clients who are “hardest” to treat:
 Effective intervention for persons who are pregnant, have co-occurring mental health or
other medical diagnoses, are violent or otherwise involved with the criminal justice system,
etc.
Consistent and relatively safe.
Balancing and not symptom, syndrome dependent.
National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Section I: Acudetox 15
 The NADA Acudetox Treatment
Acudetox involves a simple, standardized five-point auricular (ear) acupuncture modality. NADA-
style treatment incorporates frequent acudetox sessions, an herbal tea blend and the use of ear
seeds and/or magnetic beads all within the context of addictions and behavioral health treatment
and prevention programs and mutual support fellowships. Acudetox supports the treatment and
recovery process by making the client stronger from the inside.

 Acudetox involves the gentle placement of five small, sterilized, disposable stainless steel
needles in specific sites on each ear of a client undergoing treatment.
 The recipients sit quietly in a group setting for 30 - 45 minutes.
 Treatment is offered frequently, even daily if possible initially.
 The treatment is a non-verbal process with minimal interaction between client and
provider.
 The treatment benefit is immediate, tangible and apparent even to someone entering the
treatment center for the first time, and can be provided as an initial treatment intervention
before clients have developed a relationship with the counseling staff.
 Acudetox can be offered prior to an extended process of assessment and diagnosis.
 Acudetox has been shown to significantly decrease cravings for alcohol and drugs,
withdrawal symptoms, relapse episodes, anxiety, insomnia and agitation.
 Acudetox often helps participants become relaxed and more comfortable with their own
thoughts, enabling them to experience a sense of “letting go” of tensions and
apprehensions, and supporting quiet participation in a group setting with others who are
involved in the process of recovery.
 Acudetox facilitates relationships with self and others.
 Acudetox is effective regardless of the client’s level of motivation and tends to increase the
client’s readiness and willingness to participate in treatment.
 Acudetox improves the effectiveness of other program components.
 Acupuncture needles don’t put anything into the client; rather they remind the client of
what he or she already has.
 Acudetox opens up possibilities on the body, mind and spirit levels.
National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Section I: Acudetox 16
Unique Benefits of Using Acudetox in Behavioral Health Settings

Effective across types of addictions

 Outcome and anecdotal clinical reports indicate effectiveness with the commonly used
addictive substances and combinations of substances, and with behavioral/process
addictions such as gambling and sex addiction. Other interventions often target only
specific drugs.

Effective throughout the treatment/recovery process

 Originally developed for detoxification, the NADA protocol has since shown efficacy
when used in pre-treatment/harm reduction settings, throughout the stages of treatment and
as a relapse prevention and support for ongoing long-term recovery.
 It is consistent with 12-step recovery and other mutual support fellowships.
Effective along the continuum of care
 It has successfully been integrated with a wide range of addiction treatment models
including those utilizing medications.
Accessible to men, women and adolescents. Accessible cross-culturally.
Treats the whole person – body, mind, spirit, and emotions – just as addiction impairs the whole
person. It has a comprehensive, not compartmentalizing effect.
Non-verbal and non-performance (while most other treatment interventions are both).
Elicits immediate and long-term effects
 With the exceptions of medications administered, few treatment processes yield immediate
relief of suffering. Most promise future improvement.
Few complications and adverse reactions. Non-addictive.
Simple and flexible and inexpensive. Easily integrated into treatment settings.
Improves treatment relationships and the treatment environment. Relieves staff stress.
Improves treatment engagement, retention, and outcomes. AMA/APA rates decrease and
successful completion rates increase.
Paradoxically even more effective with the clients who are “hardest” to treat:
 Effective intervention for persons who are pregnant, have co-occurring mental health or
other medical diagnoses, are violent or otherwise involved with the criminal justice system,
etc.
Consistent and relatively safe.
Balancing and not symptom, syndrome dependent.
National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Section I: Acudetox 17
Psychosocial Characteristics of the Acudetox Protocol
 It is a non-verbal process.
o The treatment will be just as helpful if the patient lies to us.
o The treatment will be just as helpful if the patient is ashamed to speak about certain
issues.
o Patients will be able to learn about themselves and process troublesome issues more
gradually and comfortably.
 The patients can be engaged in helpful treatment even before they are able to tolerate
intense or personalized one to one interactions comfortably.
o Needy, fearful patients can be engaged in treatment before they can tolerate a
bonding relationship with staff.
o Paranoid, antagonistic patients are able to accept help in spite of their lack of trust.
o Patients with low self-esteem and a lack of hope can begin their treatment
participation at a realistic level.
o Patients who are also trauma victims will be able to participate in treatment even
though they are fearful of interpersonal relations.
o Hence 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.
o 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.
o Confrontation about drug use is not necessary because a patient can be helped even
while they are in denial about the need for treatment.
o It is possible to provide kind, soothing, attention without the risk of enabling the
addictive process.
o Developing trust between the therapist and patient is much easier.
o The patient can relax without losing control.
o Indeed, the whole program can relax without losing control.
 Acupuncture helps the development of a meditation-like state.
o Patients become comfortable with their own thoughts.
o Patients become comfortable with their own physical processes.
o Patients learn to "let go" of tension and preoccupations.
o Patients develop their own spatial comfort zone.
o Patients learn that their private, internal process can be a source of strength and
renewal.
o Patients are able to remain comfortable while focused on the present.
o The calm stability in the acupuncture setting creates a relatively timeless process.
There is much less pressure to improve according to certain standards.

 Acupuncture treatment in a group setting creates an environment that 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.
National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Section I: Acudetox 18
o Hence patients listen, learn, and remember without being overwhelmed by
distractions.
o In summary, acupuncture helps patients participate in individual and group
treatment sessions more effectively.
 There are two components to acupuncture treatment.
o A balancing process occurs almost immediately so that the patient is more receptive
to the message of the treatment.
o Very anxious patients usually fall asleep during acupuncture.
o Tired, apathetic patients report an increased sense of vitality during and
immediately after treatment.
o Most people experience a relaxing and centering feeling.
o As the number of treatment sessions increases, the patient will feel relatively
harmonious most of the time.
o Hence, experienced, successful patients will no longer fall asleep during sessions.
These patients will also not need to have acupuncture as frequently to gain the same
effect.
o An outside observer might believe that acupuncture is less effective when the
patient no longer falls asleep in the session. It is important to understand that just
the opposite is the case. Acupuncture treatments become more effective as time
passes. The phenomenon of "tolerance" which is so typical in pharmaceutical
medicine is not present with acupuncture.
o The actual "message" component of an acupuncture treatment often has a delayed
onset of several hours.
o As the patient becomes more balanced and receptive, this message becomes more
effective over a longer period of time.
 Defining the mechanism of acupuncture as "stress relief" is a serious misunderstanding.
o "Stress" is usually someone else's fault so that treating the victim of stress can only
be temporary at best--like giving a child ice cream after the dentist.
o All of our patients know that alcohol, heroin, cocaine are excellent "treatments" for
stress.
o Acupuncture is valuable because it helps the patient prepare for the future, not
merely cope with the past.
o We should judge the value of an acupuncture session not by the level of sedation
during or after the session, but rather by how well prepared the patients are for
counseling, groups, and other challenges.

Adapted from Michael 0. Smith, MD, DAc

National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Section I: Acudetox 19
National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Section I: Acudetox 20

Clinical Effects of Acudetox:

Clients Report:
Relaxation
Stress Reduction
Craving Reduction
Withdrawal Symptom Reduction
Mental Clarity
Increased Sense of Purpose/Wellbeing
Better Sleep
More Energy
Better Appetite

Program Effects of NADA Acudetox:

Programs report:
APA/AMA rates drop
Successful completion rates improve
Client and staff satisfaction improves
Incident reports decrease
e.g., violent behavior and emergency calls
PRN medication and dose increase requests decrease
Medication compliance improves
Clients engage more deeply in therapeutic activities

Systems Effects of Acudetox (especially when staff and families are treated):

Programs/relationships shifted.
Staff burnout decreased.
Staff who receive wellness benefit, report stress relief and decreased smoking, eating etc.
Decrease staff turnover.
Improved job satisfaction.
Improved job performance
Improved camaraderie and team building
Fewer staff sick days.

Clients are more present to family and community.

Families are more engaged in their own recovery.
Decreased criminal recidivism.
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Learning the NADA Protocol

Point Descriptions and Locations

Technique Mastery
Trial Treatments and Clinical Experience
Ear Seeds/Beads
Sleep-Mix Tea
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Auriculotherapy

Auriculotherapy is a therapeutic modality in which stimulation of the external ear is utilized to

alleviate health conditions in other parts of the body. The ear is considered to be a micro-system,
like the hands and feet, a reflection of the entire body. In ear acupuncture there is an orderly,
anatomical arrangement of points based on an inverted fetus or homunculus (little man)
perspective in which the head is reflected on the lower part of the ear (lobe) the hands and feet
towards the top and the internal organs located within the depressions of the outer ear.

from the Auriculotherapy Manual by Terry Oleson

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Auricular Topography and Landmarks

(David Wurzel, LAc)
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NADA EAR PROTOCOL

The NADA five points were chosen based upon Oriental medical theory and clinical indication
as well as lower electrical resistance and pain sensitivity. All the five points serve to balance the
body’s energy and assist the body’s healing processes. Together the combined effect of the five
point protocol is, as referred to in Oriental medicine, a yin tonification, restoring the calm inner
qualities akin to serenity.

In general, needling the Sympathetic and Shen Men points produces calming, relaxing and
centering effects. The other three points, Kidney, Liver, and Lung, correspond to yin organ
systems in Oriental medicine. The yin organs are seen as internal, nourishing, nurturing,
restorative and supportive. They store the vital substances such as energy and essence. In
modern Western medicine, kidney, liver and lung relate to detoxification and cleansing (the
organs of elimination).

All five points are easy to locate on the surface of the external ear. The points are found in the
dark, deep, cavernous part of the ears and underneath ridges, i.e., the yin side. In general, the ear
points are found at places where there is a change in the anatomical structure. These locations
and changes become clear with a little practice. It is not necessary to memorize the names of the
ear’s anatomical structures.

Using a clock analogy; Shen Men is at 12:00, lower Lung at 6:00 and Liver at either 3:00 on the
left ear or 9:00 on the right.
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Sympathetic Point
TheTheNational
Overview:
Acupuncture Detoxification
Sympathetic point balances the sympathetic and parasympathetic nervous
Acudetox Protocol
systems. It has a strong analgesic (pain relieving) and relaxant effect upon internal
organs and dilates blood vessels
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Sympathetic

Point Location: Locate this point by following the line of the inferior antihelix crus, hidden
under the rim of the helix.
Needle Technique: Insert the needle parallel to and along the inferior crus.
Possible needling challenge: If the rim of the helix is folded so close that it touches or almost
touches the inferior antihelix crus – start with the tip of the needle at the
superior helix crus and then slide it inferior to get the tip beneath the rim.
Indications:
 Body Level
o Balances sympathetic nervous system, has a strong analgesic and relaxant effect
upon internal organs and dilates blood vessels.
 Mind Level
o Reduces epinephrine/norepinephrine levels for relaxation
 Spirit Level
o Calms the spirit, provides for serenity (yin time)
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Shen Men

Overview: Shen Men translates roughly as spirit gate. Needling this point generally helps to
alleviate anxiety and nervousness and produces a calming, relaxing effect. It helps
the process of going within, supporting the internal journey of recovery.

Point Location: The point lies in the triangular fossa. The zone runs from just inside the tip of
the “U” to one-third of the way along the superior antihelix crus, under the
rim.
Needle Technique: The needle should be inserted either perpendicularly into or at a slight
angle to the point
Possible needling challenge: If the triangular fossa is very large or uneasily detected, then use
a location that is directly in line with the Kidney point, at the half-way
point between the lower edge of the inferior helix crus and the superior
edge of the superior helix crus.
If the triangular fossa is hidden or difficult to distinguish because of a
large helix that folds over the superior crus, locate the point on a line
superior to the Kidney point and place the needle superiorly at a 45 angle.
Indications:
 Body Level
o Alleviates pain, tension, excessive sensitivity; reduces hypertension
 Mind Level
o Calms the mind and relieves anxiety, depression, insomnia and restlessness
 Spirit Level
o Opens connection to spirit (opens one’s heart); ability to love self and others
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Kidney Point
Overview: The kidney in Chinese medicine is associated with growth, development,
reproduction, courage, intelligence and the aging process. It is believed to store the
source energy and the essence, or Jing. It is associated with fear, resolve and the
will.

Point Location: This hidden point lies within the superior concha under the anti-helix
ridge, inferior to Shen men (along the axis of the ear). Observe the shape
of the lower edge of the inferior helix crus. There is an increase in the
angularity of that edge just above the location of the Kidney point.
Needle Technique: The needle is inserted at a 45° angle from vertical pointing towards the top
of the head.
Indications:
 Body Level
o Stimulates physiologic and hormonal functions
 Mind Level
o Influences mental state and happiness, relieves fear
 Spirit Level
o Reminds client of his or her will and intention to overcome the addictions; allows
client to hear the positive
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Liver Point

Overview: Oriental medical theory associates the Liver with resolving anger and aggression
and with keeping both the emotions and the body’s systems moving smoothly. It is
responsible for planning, vision and insight.

Point Location: The point can be found by following the crus of the helix to the wall of the
cavum concha. The zone includes the area superior and inferior to that point.
(The practitioner will often need to visually extrapolate where the concha root
would extend.)
Needle Technique: The needle may be inserted perpendicularly or at a slight angle to the ear.
Be careful not to needle completely through the ear.
Indications:
 Body Level
o Simulates physiologic and hormonal functions; relieves muscle cramps
 Mind Level
o Aids in clear thinking and decision making; relieves frustration, depression, anger
 Spirit Level
o Helps client connect with the internal self and find direction in life
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Lung Point
Overview: In addition to respiration, the Lung is also involved in immunity and protecting the
body from disease. The Lung is associated with the grieving process and with
letting go. It is responsible for inspiration, respect and connection with the heavens.

Point Location: The point is found in the middle of the lower region of the cavum concha
inferior (relative to the ear axis) or just superior to the Heart point (the most
central, deepest area of the cavum concha).

Needle Technique: Visually locate the deepest, most central portion of the cavum concha
(the Heart Point) and insert the needle just below in line with Shen Men
and Kidney along the axis of the ear (or just above the Heart point for the
alternative location). Often the highest point on the anti-tragus can be
used as a landmark to guide the needle into the inferior concha and
directly to the Lung point.
Indications:
 Body Level
o Lung is an important organ for detoxification; regulates pores
 Mind Level
o Aids in regulation of grief/sadness; improves sense of connection and self respect
and integrity
 Spirit Level
o Reminds client of connection with heaven; provides inspiration
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Acudetox Rapport and Needling Techniques

 Be sure you are prepared, calm and focused. Have the needles ready for use. Always be
mindful of your body positioning so that you are stable and introducing yourself into the
client’s space appropriately. Approaching the client from the front and to the side tends
to make him or her more comfortable than from straight-ahead or from behind.
 Be sure the client is prepared, sitting comfortably with both feet on the floor, upright and
present to the treatment, with both ears already prepared with alcohol swabs (or cleaned
with an alternative to alcohol if the client is on disulfam/Antabuse or Flagyl).
 Speak calmly, directly, in low tones, explaining the procedure to the client if it is his or
her first treatment. Ask if the client is ready. If the answer is “no”, guide the client into
taking several deep, long and relaxing breaths. A client with upper respiratory problems
may not be able to take a deep breath. In this case, guide them to relax and breathe
calmly.
 Make sure that you position yourself so you can needle the ear from the front –side of the
client. You may ask the client to turn his or her head or move forward in the chair.
Move your body if necessary being mindful of the other clients.
 Hold the needle handle with your thumb and index finger. Hold as far down the handle
as possible without touching the shaft. Do not touch the needle tip. (You may use your
other fingers to stabilize on the client’s ear or area around the ear. This can be grounding
for you and the client and provide a message of safe touch.)
 Visualize the location of each point remembering these points are all on relatively yin
surfaces of the ear (triangular fossa, cymba concha, cavum concha). These areas will
generally look darker than the adjoining raised surfaces.
 Using the needle as a pointer, visually follow the needle tip to the acudetox point.
 Ask the client to take a deep breath and on the exhalation insert the needle by touching
the tip to the point and giving it a gentle turn clockwise. Insert the needle approximately
1/8 inch. Some clients prefer you coach them with the breathing; others prefer you insert
the needles quickly without too much fuss. Using the exhalation during needle insertion
may decrease the sensitivity.
 Some clients are quite fearful. Take your time with those clients, encouraging them (and
yourself) to breathe deeply.
 Some clients experience an initial pinch that should subside after a moment. If the client
continues to feel discomfort you may adjust the needles slightly.
 If a client is sensitive or flinches over a point, you may pause momentarily and
encourage the client to tell you when ready for the next insertion. Some clients find that
vigorously rubbing their ears prior to the alcohol swabbing helps to decrease the
sensitivity.
 Insert the needles confidently, calmly and quickly. If a needle is hanging down loose you
may return it to the original insertion angle and give an additional turn.
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 Avoid words like, “OOPS”, “SORRY”, and “UH OH” or telling the clients they have
“good” or “bad” ears. Always remember that there is a person attached to the ear you are
needling.
 After the needles are inserted, check to see if the person is all right – not woozy, flush or
pale.
 Needles often fall out after insertion. If this occurs within the first few minutes, you may
insert another, with the client’s permission, or leave it out as the point has already been
stimulated. If a needle falls later in the session, do not re-needle.
 Fallen needles. All needles must be accounted for by the end of the session. Do not
disrupt the client’s treatment unduly looking for lost needles. If the needle is not visible,
wait until all the needles are removed at the end of treatment to search for it. If you
recover a needle during treatment, follow the instructions provided by the agency for
handling fallen needles to insure a proper needle count and proper disposal. Do not reach
to remove a needle from a client’s body, especially the chest or lap areas. Verbally guide
the client to retrieve the needle. You may ask for permission to remove a needle such as
one on a collar or shoulder if the client cannot see it.
 If a client attempts to hand you a needle, do not take it from him or her. Make sure that
the client places the needle in the hazardous waste container or another designated
impermeable container safely and in a manner that does not put you at risk of a needle
stick.
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Needling Cautions: Clinical realities that require management and special consideration.
Deficiency/weakness: Clients who are extremely “deficient” or weak may need a lighter
treatment using seeds or fewer needles. For example, clients who are HIV positive or pregnant
or just off a long, hard run of drug use may be weak and more sensitive to the needles.

Fatigue/hunger: Encourage clients who are excessively fatigued to rest and clients who are
excessively hungry to eat. Some programs supply food. Others explicitly instruct clients to eat a
light meal prior to acupuncture treatment.

Broken skin or bruising: When clients have pimples, cuts, sores, rashes, irritation, infection,
bruises or hematomas (swelling containing blood), etc. at the point location, do not needle that
point until the site has fully healed. If a client has a wart or scar tissue at a point location,
likewise do not needle it.

Hemophilia: Clients who are hemophiliacs or “bleeders” may still be treated even though there is
some bleeding possible when needles are removed. Bleeding is minimal because of the
minuscule size of the needle hole. It is appropriate to ask such clients about their medication
compliance and monitor them more carefully. The same applies to clients on anti-coagulation
medications. However, these conditions are not contraindications for acudetox.

High/intoxicated: Clients who have just used or are still very intoxicated may not get as much
benefit from the treatment.

Fear of needles (Belanephobia): Clients with fear of needles may need additional support in
order to feel safe with the needling process. Allow them to observe or speak with other clients.
Breathing exercises and options such as just trying one needle, sitting without needles or using
press seeds/balls can be helpful.

Needling Complications: Managing adverse clinical manifestations due to acudetox treatment.

Needle shock (postural hypotension, vagal reaction, needle sickness or fainting):

 Although this occurs infrequently, always look for signs during and immediately after
needle insertion.
 Symptoms include loss of color, sweating, dizziness, lightheaded sensation, nausea
and fainting. Sometimes a client will just say, “I don’t feel so good.”
 If a client feels faint or faints while sitting up, calmly remove the needles as quickly
as possible.
 Raise legs to a horizontal position and lower the head. It is recommended that clients
be placed safely on the floor if possible (be sure there are no contaminated needles in
the area on which the client will be lying), making sure that the airways are not
obstructed.
 If client feels chilled, help him or her to stay warm.
 Symptoms resolve quickly and client may exhibit relaxed behavior as if a full
treatment occurred.
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 Eating prior to treatment decreases the possibility of needle shock even further.
 Do not attempt to needle again in the same day.

Hematoma (swelling due to bleeding under the skin):

 May occur when a needle is removed.
 Have the client apply pressure with a dry cotton ball.

Needle through ear:

 May occur on insertion, particular in the liver point.
 Does not cause problems but may be disconcerting for the client.
 Adjust depth of needle insertion – review needling technique.

Infection:
 Rare with proper infection control procedure.
 Do not needle the infected site until it has healed.
 Encourage client to clean and apply first aid or refer to medical personnel.

Headache:
 During treatment (headache that comes on shortly after insertion of needles), remove or
loosen sympathetic point.
 For post treatment headaches, first determine if this was a one-time occurrence or if it has
happened several times. If it occurs after several treatments, do not insert the
sympathetic point next time. If this does not help then try reducing the length of the
treatment session.

“Healing Crisis”. Hering’s Law of Cure: a theory out of homeopathy asserts that as the body,
mind and spirit clear past trauma, a flare-up might occur. Sometimes a client will report a flaring
up of symptoms, if so, it typically happens in the first 24 – 48 hours after treatment, will not last
for more than 24 hours and will not be a new symptom. Rather than viewing a symptom as a
negative, encourage the client to view it as part of the healing process. Often the client will feel
significant improvement or change after such an event. If the symptom is new, or one that the
client does not remember having before, encourage the client to contact an appropriate healthcare
provider.

Please refer to Appendix “C”: Acudetox Risk Management for further detail regarding the
handling of needles and adverse events.
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Ear Seeds or Magnetic Ear Beads

The NADA protocol provides the most effective results via needle stimulation, however seeds or
beads applied to the points may also provide support to clients. Seeds/beads are placed on the
point and secured with a small piece of tape. The seeds traditionally used are vaccaria (black
radish) seeds. Beads vary in metal content, usually gold or silver, size and whether or not they
are magnetized.

Seeds or beads are non-invasive and have a milder effect than needles. Use them when a client is
unwilling or unable to receive acudetox and as a support to clients between needling sessions.
They stimulate the points and provide a tool that the client may use when not at the program by
gently pressing on the seed/beads. Seeds/beads may also be used for infants and children.
Though ear seeds/beads provide a useful adjunct to the NADA protocol, they cannot replace the
powerful effect of needling. One program in Chicago was forced to switch from needling to the
use of seeds/beads due to a regulatory change and noted a 30% increase in the positive urinalysis
rate.
Seeds/beads may be left on for up to one week or taken off as desired.
Place the seeds/beads on the points with instructions to clients regarding stimulation, removal
and disposal. It is difficult to place a seed or bead on the sympathetic point, but all others are
accessible. Using tweezers will facilitate the process. Caution clients regarding over-stimulation
as it may break the skin.

In recent years, practitioners have found ear magnets useful for many conditions including
Attention Deficit Disorder (ADD), Attention Deficit Hyperactivity Disorder (ADHD),
generalized anxiety, autism and violence in youth. Experience shows that placing a gold (or
sometimes silver) magnet on the “Reverse Shen Men,” on the back side of the ear approximately
behind the Shen Men point can have dramatic and lasting effect.
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Sleepmix Tea
Developed by Michael Smith, this tea is a natural blend of Western herbs formulated to help in
detoxification, aid in digestion, prevent insomnia, promote relaxation and reduce stress. The
mixture – 3 parts chamomile and 1 part each peppermint, yarrow, hops, skullcap and catnip – is
reported to calm and soothe the nervous system, stimulate circulation and eliminate waste
products. Because the ingredients are considered food compounds, there are no legal restrictions
on the tea’s use.
The formula can be used for the treatment of conventional stress and insomnia as well as
providing an adjunctive support in addiction treatment settings. It has been shown to be
particularly effective in the management of alcohol withdrawal symptoms (one facility
discovered its seizure rate increased when the program ran out of tea).
Programs can brew tea on site and/or offer teabags to clients to drink throughout the day
reserving enough for a cup before going to bed.
The constituents of Sleepmix tea have been reported to have the following effects:
Hops: Calm the nervous system, stimulate appetite, dispel gas and relieve intestinal
cramps. Recommended for nervous diarrhea, insomnia and restlessness.
Yarrow: Stimulate appetite; relieve stomach cramps, flatulence and gastritis, and to
relieve gall bladder and liver problems by stimulating bile flow.
Catnip: Relieve upset stomach, colic, spasms, flatulence and stomach acidity.
Peppermint: Useful for nervousness, insomnia, cramps, coughs, migraines, poor digestion,
heartburn, nausea, abdominal pains, headaches and vomiting due to nervousness.
Skullcap: Good for spasms, convulsions and nervous conditions such as excitability,
insomnia and general restlessness. Also recommended for neuralgias and
delirium tremens.
Chamomile: Has been used for flatulence, colic, dyspepsia and restlessness.
Preparation: 1 teabag per cup of boiling water. Brew mild (steep 1 – 2 minutes) or strong (3 –
5 minutes). Drink hot or cool. If sweetening is desired, honey is preferred
because of its yin qualities (avoid artificial sweeteners such as
aspartame/NutraSweet and sucralose/Splenda). The taste of the tea may be
considered slightly bitter with longer steeping times. Adding lemon may reduce
the bitterness.
May be used on a continual basis. Caffeine free. Will not cause a.m. drowsiness
when used as a sleep aid.

Sleepmix tea can be ordered from:

Nutra-Control
PO Box 1199
Old Chelsea Station
New York, NY 10011
212-929-3780
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Learning the NADA Protocol

Partnership with Clients
Communal Treatment Approach/Effect
Boundaries and Self-Care
Creating the Atmosphere
Informed Consent & Client Information
Documentation
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ADS Relationships: The Spirit of NADA

Beyond the actual needling treatment, a key element of the NADA protocol specifies qualities of
behavior and attitude on the part of the clinician, consistent with what is known as the “Spirit of
NADA”.
Relationships with clients
The NADA protocol is a way of being with clients in a much larger sense than just the
application of the five ear needles. NADA-style treatment involves a partnership with the
client towards supporting his or her transformation and recovery. Every aspect of an
ADS’s interaction with persons in need, is to help them help themselves.

The treatment is a client-centered interaction that to be optimally successful requires

practitioners to adopt the following principles:
 Opening access to treatment. Eliminating unnecessary bureaucratic, socio-economic
and environmental barriers to starting a program of recovery. Minimizing necessary
ones as much as possible.
 Understanding that the healing potential is within every client.
 Using respectful communication and "chair-side" manner. Addressing client fear
directly and minimizing discomfort.
 Empowering client choices regarding receiving treatment.
 Believing in the good and potential for change within clients, even when they
themselves cannot.
 Minimizing the importance of the practitioner by not interfering, taking ownership, or
controlling the clients’ outcomes/processes.
 Supporting and endorsing other recovery processes, including psychosocial
interventions and mutual support fellowships (such as AA, NA and others).
 Minimizing the intrusiveness of requirements. Keeping the "fussiness" of the process
to a minimum to emphasize that the benefits come from within. Keep it simple. Get
out of the way.
 Minimize the verbal interaction to maximize the non-verbal experience.
 Allow the client to have their own experience as long as it does not interfere with
others, for example, allow them to sleep, read, fidget etc.
 Creating opportunity for a wide range of client experience by not creating overt
expectations (for example of "relaxation"), and by not doing other interventions
during treatment time.
 Creating an environment conducive to the needling treatment and appropriate for the
client population. Supporting yin nurturing treatment with a dimly lit, quiet room.
 Support the communal treatment effect—the "group Qi".
 Creating safety by maintaining appropriate boundaries.
 Providing safe touch. Confining contact to the ear or head near the ear.
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Relationship with self

Working with addicted and recovering persons can be very challenging work. NADA
recommends that ADSes develop their own forms of self-care to prevent burnout, reduce
stress and maintain wellness. From a practical sense, it is nearly impossible to facilitate
others’ healing beyond that which we ourselves are willing to do. Self-care techniques
can include:
 Receiving NADA protocol treatments.
 Attending Al-Anon or other 12-step fellowships. If you work with addicted clients
you automatically qualify as an Al-Anon or Nar-Anon member.
 Working though issues raised by delivering the NADA protocol to others. Doing this
style of work may bring up the practitioners' own unresolved issues regarding trauma,
codependence, etc.
 Addressing issues of discomfort such as difficulty inflicting pain or imposing
program consequences.
Relationship with program
The NADA protocol is not a stand-alone treatment for addictions and behavioral health.
The treatment works best when delivered within the context of current addictions and
behavioral health treatment models, matched to the clients' particular medical and
psychosocial needs.
 Cultivating relationships with the treatment team
 Communication regarding observations and clients needs
 Seeking supervision as needed especially regarding safety, accuracy and clinically
relevant issues. Please note: ADSes who are not licensed acupuncturists (or other
healthcare practitioners whose scope of practice allows them practice acupuncture
without supervision) must practice under supervision as required by state or local
regulations.
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Acudetox documentation
“If it is not documented, it did not happen.” So says the old adage in healthcare provision. Proper
documentation in the client treatment record in a manner consistent with other program
components, state and local laws and HIPPA requirements allows the NADA protocol to be a
vital part of addictions and behavioral health treatment. Documentation facilitates
communication with the program and other treatment providers. Documentation provides a clear
picture of the course of treatment and represents an important part of risk management for
treatment programs.

Prior Informed Consent: It is essential that clients provide informed consent prior to receiving a
treatment. The signed and witnessed consent form will be included in the client record. This
may be a separate form or a specific acupuncture reference in a general consent to treatment
form used by a particular program (Appendix “G” includes sample forms). Programs that have
ADS-trainees providing direct client treatment should include that specification in the consent
form language as well.

Treatment Documentation: In general, minimum documentation of each needling treatment

includes the date, treatment delivered (and/or if any of the 5 needles are left out or removed),
client’s response to treatment (or any adverse events) and the ADS’s signature. Be sure to
document any unusual occurrences or adverse events. Some programs developed forms to
simplify the documentation process. Some programs use a SOAP (Subjective, Objective,
Assessment, Plan) notes format.

Client Response Documentation: Many programs gather information from clients in the form of
evaluations, survey, symptoms checklists etc. These can provide valuable process and outcome
information for program evaluation. Be careful about overburdening clients or staff with extra
paperwork or gathering unnecessary information that never gets used. Clients should not be
asked to fill out these forms while the needles are in.

Needle Logs: Many programs also maintain a needle log to insure accountability of needles and
document any lost needles. Incident reports are also to track missing needles and adverse events.

Client Information/Instructions: Be sure to provide clients with clear information about the risks
and benefits of the NADA-style ear needling which include clear instructions regarding what to
do before, during and after the treatment sessions. Remind clients verbally and post program
rules regarding client safety. Remind new clients prior to the first session. Instructions can be
tailored to the program and clientele and include:
 preparing their ears prior to treatment,
 not playing with any needles that fall out during treatment,
 securing their own fallen needles in whatever manner the program has established that
protects others from contacting the contaminated needles. (e.g., placing them in a safe
visible location, contacting the attending ADS, etc.),
 avoiding contact with any needles that may be from someone else,
 staying seated while the needles are in their ears,
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 not lying or sitting on the floor in the general area where needles may have fallen. (For
clients with back problems, special arrangements can be made for the clients to lie down
away from possible contact other clients’ fallen needles,
 using the restroom prior to treatment. If a client does need to use the restroom during
treatment, or leave for any other reason, remove all needles. (The ADS may replace them
with sterile, unused needles when the client returns if appropriate.)
 how to handle needle removal according to the program’s established protocol.
 how to behave during the treatment experience, i.e., silence or low talking, respect for
others, what to do if they are uncomfortable, etc.
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Public Health, Safety and Regulatory

Concerns
Exposure Control/Safety
NADA Clean Needle Technique

See Appendix “C”: “Acudetox Risk Management”, for more complete

details especially regarding program development.
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National Acupuncture Detoxification Association
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NADA Clean Needle and Exposure Control Procedures

While acudetox is generally considered a relatively safe procedure, as is acupuncture in general,
there is none-the-less certain inherent risks to which clients, ADSes, and cleaning personnel may
be exposed.

These risks include accidental needle sticks and exposure to blood borne pathogens, and
improper handling and disposal of used needles and contaminated items.

Exposure Control Plan. The Occupational Safety and Health Administration (OSHA) requires
that all work settings that have a “reasonable risk” of exposure have a written plan for how to
minimize such risk and what to do in the event of an exposure. Programs must develop and
implement an appropriate Exposure Control Plan as required by OSHA, and also provide annual
blood borne pathogens training to all personnel who have a reasonable risk of exposure to
contaminated acupuncture needles and other materials that may have become contaminated by a
patient’s blood or other body fluids. See Acudetox Risk Management, Appendix “C”, for further
details on developing an exposure control plan and contacting OSHA. Programs, ADSes and
acudetox supervisors must also be familiar with and abide by federal, state and local laws as they
pertain to the acupuncture in general and NADA-style treatment in particular.

The Exposure Control Plan includes a system for reporting exposure, information on testing for
infection, treatment options available and monitoring for side effects of treatment. In developing
the Exposure Control Plan, programs will evaluate the need for using gloves during needle
removal. Factors to consider in whether to require gloves while removing needles include the
type and number of clients served and the experience of the ADSes. Whether or not a program
requires the use of gloves when removing needles, OSHA requires that gloves be available for
workers if they desire to use them. Closed-toe shoes should be worn by ADSes to prevent
inadvertent needle sticks from dropped needles.

Universal precautions and blood borne pathogens

The Centers for Disease Control and Prevention (CDC) define Universal Precautions as “a set of
precautions designed to prevent transmission of human immunodeficiency virus (HIV), hepatitis
B virus (HBV), and other blood borne pathogens when providing first aid or health care. Under
universal precautions, blood and certain body fluids of all patients are considered potentially
infectious for HIV, HBV and other blood borne pathogens” (Centers for Disease Control and
Prevention, 2005). In other words, all human blood and certain other human body fluids are
treated as if known to be infectious for blood borne pathogens.

While Universal Precautions cover many types of body fluids, in NADA-style treatment settings
blood is the fluid of concern as on occasion clients’ ears may bleed after the removal of the
needles (Universal Precautions do not apply to sweat, tears, nasal secretions or saliva unless they
contain visible blood). Universal Precautions include the use of Personal Protective Equipment
such as gloves when there is a reasonable chance of the healthcare provider coming in contract
with clients’ body fluids or contaminated items (defined as “the presence or reasonably
anticipated presence of blood or other potentially infectious materials on an item or surface”) as
well as measures to prevent inadvertent needle sticks.
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The Clean Needle Technique for Acupuncturists (CNT) is the recognized standard of care for the
acupuncture profession in regards to blood borne pathogens and needle stick prevention
(National Acupuncture Foundation, 1997). The 5th edition includes special provisions for
performing acupuncture in public health settings that outlines specific modifications of the
standard techniques. While this manual is the de facto standard for the acupuncture profession,
as will be noted shortly, programs are required by federal law to abide by the regulations
prescribed by OSHA and other federal entities.

There are several factors that influence the overall risk of exposure to blood borne pathogens
including the number of infected individuals in the client population, the pathogen involved, the
type of exposure (e.g., needle stick versus skin contact), the amount of blood involved and
number of blood contacts (Centers for Disease Control and Prevention, 2003).

Several larger metropolitan areas report at least 90% of IV drug users are positive for HBV,
hepatitis C (HCV) and/or HIV. Even so, very few exposures result in infection. Because
acupuncture needles are solid (as opposed to hollow-bore hypodermic needles), they carry very
little risk of carrying infected blood. With proper diligence inadvertent needle sticks with
contaminated needles can be prevented. Proper disposal of blood-contaminated items such as
used cotton balls further decrease the chances of blood borne pathogens exposure.

Because of the high occurrence of HBV infection among IV drug users, the Centers for Disease
Control and Prevention recommend universal HBV vaccination for individuals who work in
facilities in which these clients are treated (Center for Disease Control and Prevention,
Healthcare settings serving IDUs). Because the vaccinations are given via injection and
therefore considered invasive, programs cannot mandate that their employees receive the
vaccination series. ADSes are advised to consider the vaccination series if they have not already
done so.
Tuberculosis (TB) exposure is another concern in several metropolitan areas. The Centers for
Disease Control and Prevention suggest that programs develop a TB exposure control plan
designed to reduce the risk of TB transmission between clients and patients. Staff should be
encouraged and can be required to undergo regular purified protein derivative (PPD) testing.
Even very low risk programs should have a written procedure for how to proceed if a client with
known or suspected active TB is encountered.
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NADA CLEAN NEEDLE TECHNIQUE
Be Mindful. Be careful. Be focused and alert. Pay attention. Many accidents can be prevented
by mindfulness and care. Keep your work areas clean.
Have clearly outlined policies/procedures customized for the specific program and
population.
Use Universal Precautions and avoid contact with all blood.
Wear closed-toed shoes.
Before Treatment:
Set up the room. Be sure that you have all the supplies necessary including hand
cleaner/sanitizer, biomedical waste containers, cotton balls/swabs, gloves and lined trashcans.
Wash your hands thoroughly with anti-bacterial soap before beginning the session.
During Treatment:
Have clients prepare their ears with alcohol swab. Allow to dry naturally. Clients on
disulfam/Antabuse or Flagyl can use a non-alcohol-based preparation or use soap and water.
Wash/clean your hands during the session as needed. If no hand washing station is available
in the room, use alcohol-based hand rubs or antibacterial gel, wipes or foam between clients
and/or after contact with anything except supplies. Wear gloves if you have any open
sores/wounds on your hands that might come in contact with clients.
Use only pre-sterilized, single-use needles from unopened packages. Dispose of any needles
if you have any doubt of their sterility. Touch only the handle. Discard any needles if the tips
touch any surface other than the intended ear point. Discard any unused, opened needles at the
end of the treatment day. (Note, no bleeding occurs during needle insertion). Use good needle
technique (see Section IIA).
Provide clear client instruction. Make sure that clients are aware of how to respond during the
treatment session, including what to do if a needle falls out or if they require assistance. Ask
clients to sit upright with both feet on the floor while being needled. (They can adopt a more
comfortable position after the needles are in.) It is recommended that clients not lie down in the
general needling area. If a client has a physical need to lie down, try to position that person as
safely as possible and be sure to account for all needles used.)
Remain in the room and alert to client's needs. You are responsible for your own and your
clients' safety during the treatment session. Do not leave clients unattended during treatment.
Minimize fallen needles by minimizing client movement during treatment. If a client needs to
leave the room for any reason, remove all the needles first.
Use extreme care when retrieving fallen needles to minimize the risk of a needle-stick. Use a
magnet, hemostat or tweezers to pick up stray needles. (Use hemostats or tweezers to remove
needles from magnets.) Do not take a needle from someone's hand. Have client's place needles
into impermeable containers for disposal or directly into a sharps container. Follow your
program's Exposure Control Policy should a needle-stick occur.
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Needle removal presents the highest risk for exposure. The practitioner or the clients can
remove needles. There are risks and benefits of each model. (Programs will need to set
policy/procedure that best suits their situations.)
 Clients remove needles: Under supervision, clients remove their own needles and
staunch any bleeding that occurs (using either a cotton ball or a cotton-tipped swab). It
may be helpful to provide a station with a mirror, a biohazard container, cotton
balls/swabs and hand cleaner, and a system for counting needles. Clients wash their
hands with soap and water, alcohol-based hand rubs, antibacterial gel, wipes or foam
after removing needles whether or not there was visible blood present.
 ADSes remove needles: ADSes remove needles one at a time and put each needle
directly into the red sharps container watching it all the way into the container. (Whether
or not the ADSes are required to wear gloves must be part of the program’s Exposure
Control Plan. Have gloves available regardless.) Always have cotton balls or cotton-
tipped swabs ready in your hand. Give cotton balls to client to staunch bleeding or hold a
swab on the site for several seconds with firm pressure. If the ADS is wearing gloves and
any blood gets on them, dispose of the gloves as outlined in the program’s Exposure
Control Plan and don a fresh pair before going on to the next client (please note that
while they prevent contact with blood, gloves do not protect against needle sticks). If the
ADS gets blood on his or her hands, then implement the procedures outlined in the
program’s Exposure Control Plan.
Bleeding. Usually bleeding involves just a few drops of blood and occurs immediately after the
needles are removed. Bleeding occurs 10-20% of the time and does not indicate poor needling
technique. (Holding or pressing a cotton ball/swab on the point for 10-15 seconds will usually
suffice.) Delayed bleeding may occur. Monitor clients after needle removal and before they leave
the premises.
Account for all needles used. There are many ways to insure the count. Each program can adopt
a procedure best suited to its needs.
Handle contaminated items with extreme care as prescribed by the program’s Exposure
Control Plan. Blood saturated items go into a biomedical waste container. Clean any exposed
surfaces with anti-bacterial agents or bleach wash.
Use only approved red Biohazard waste containers and approved disposal service or
equivalent. Discard all needles whether exposed or not into the hard red plastic “sharps”
containers. Watch the needle all the way into the container.
You can carry sharps containers directly to the client or use small puncture-proof containers to
collect from each client and then transfer needles into the sharps container. (Transfer containers
should be sanitized between sessions or discarded appropriately.) Do not overfill sharps
containers.
After Treatment:
Double check the room for any stray needles or contaminated materials. Sweeping with a
broom or magnet can be useful.
Secure and account for all supplies and waste. Dispose of unused needles. Secure biomedical
waste containers. Double bag all trash and remove it from the room.
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Wash your hands thoroughly.

Please note: Each program that provides NADA-style treatment needs to have a written
Exposure Plan in place that dictates policies/procedures related to this particular type of
treatment situation and the handling of needles and contaminated items, and a policy for what
steps to follow should a needle-stick or blood exposure occur. Each ADS should consider the
risks of exposure involved in providing the treatment and be familiar and comfortable with the
program's plan.

A note on grooming: ADSes need to keep their fingernails short and clean to maximize dexterity
and minimize the risk of contamination. Avoid wearing jewelry, clothing or hair styles that might
touch the client during treatment delivery.
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National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Section IV: Research 57

Research and the NADA Protocol

Research monographs are found in Appendix “H”
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Research and the NADA Protocol
(Includes excerpted material from Smith, Brewington, Culliton 1998)
Research, (a term often used broadly and inaccurately), specifically refers to a Western scientific
method of demonstrating the effectiveness of an intervention. Developed and more relevant for
testing medications, the “gold standard” of research is the randomized, double blind, controlled
trial. Carefully matched participants are randomly assigned to the study’s comparison groups. A
“control” group receives a placebo or “sham” treatment.

Good research requires considerable expertise and expense. The best designed studies involve a
large sample of subjects, a variety of measurements with a preference for biomedical markers
rather than just subject responses, follow-up over a long period of time and elaborate statistical
analysis. These carefully designed studies therefore may have little resemblance to real-world,
clinical practice. In terms of “sham” acupuncture, ear acupuncture charts indicate that all the
surface areas of the ear are active treatment locations, so “sham” or “placebo” points can only be
relatively less effective as opposed to inert substances used as placebos for studying medications.

Although there is a small but growing body of studies on the NADA protocol, the results are
mixed and difficult to decipher. The existing studies differ widely in the treatment delivered and
the outcomes measured.

H.L. Wen of Hong Kong was the first physician to report successful treatment of addiction
withdrawal symptoms with acupuncture (Wen, 1973). He observed that an opium addict
receiving electro acupuncture as pre-surgical analgesia experienced relief of withdrawal
symptoms. The point stimulated was the ear acupuncture point corresponding to the Lung.
Subsequently Wen conducted several basic clinical pilot studies which formed the basis of
subsequent research.

Results from then available placebo-designed studies support the conclusion that acupuncture’s
effectiveness in facilitating abstinence with alcohol, opiate and cocaine addicted subjects is not
due to a simple placebo effect (Brewington, 1994).

Bullock (1987) studied 54 chronic alcohol abusers in an inpatient (although they could leave
during the day), AA-based setting that were randomly assigned to either the NADA treatment or
needling at nearby ear points (the “sham” group). Acudetox receivers showed significantly
better outcomes regarding attendance, self-reported desire for alcohol and drinking episodes, and
readmission for detoxification.

Bullock (1989) replicated that study with 80 chronic alcohol abusers. Twenty-one (21) of the 40
patients in the NADA protocol group completed the 8 week treatment program as compared to 1
of the 40 sham in the sham group. Sham receivers self reported twice the number of drinking
episodes and were more than twice as likely to be readmitted for detoxification within 6 months.
(See Appendix “H”). This study, published in the esteemed British medical journal, The Lancet,
garnered considerable attention and credibility for acudetox.
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Washburn (1993) reported that opiate addicted individuals receiving correct site acupuncture
showed significantly better program attendance relative to subjects receiving acupuncture on
placebo sites. Konefal (1995) examined the efficacy of different ear acupuncture protocols with
patients with various addiction problems. Subjects (n=321) were randomly assigned to one of
three groups; a one needle protocol using the Shen Men point; the five-needle NADA acudetox
protocol; or the five-needle acudetox protocol plus selected body points for self-reported
symptoms. All groups showed an increase in the proportion of drug-free urine tests over the
course of treatment. (Subjects with the single needle protocol showed significantly less
improvement compared to the other two groups.)

Shwartz, Saitz, Mulvey and Brannigan (1999) published a multi-variant, retrospective cohort
study of 8,011 clients discharged from publicly funded detoxification programs in Boston.
Comparison of outpatient (acudetox plus traditional detoxification/counseling) programs with
residential (short-term detoxification without acudetox), showed acudetox recipients less likely
to relapse. Only 18% of the acudetox clients readmitted to treatment within six months as
opposed to 36% of the residential clients. (See Appendix “H”)

A pilot study in Klamath Falls, Oregon by Russell, Sharp and Gilbertson (2000) of 86 addicted
clients with chronic histories of arrest found a statistically significant increase in program
retention for acudetox outpatient treatment as opposed to a historical no-acupuncture control
group. Researchers noted positive trends towards fewer new arrests, fewer positive urinalysis
results, and a shorter time needed to move through treatment phases/levels.

A Yale University study (Avants, 2000) of 82 cocaine-dependent methadone-maintained

subjects, randomly assigned to three groups, found statistically significant results for cocaine-
free urines: fifty-eight (58 %) of the acudetox group as compared to 24% of the sham control
group and 9% of the relaxation video control group.

The Yale study was a pilot for a larger, six-site nationwide study that yielded less favorable
findings (Margolin, et al, 2002). This trial published in Journal of the American Medical
Association (JAMA) found no statistically significant difference between the acudetox group and
the control groups concluding, “Our study therefore does not support the use of acupuncture as a
stand-alone treatment for cocaine addiction.” (Of note, between the first Yale study and the
larger study, the protocol was modified slightly with less clinical recovery support offered to the
study subjects and with reimbursement for study participation regardless of use. The study’s
conclusion is noteworthy in that NADA has always supported the concept and practice of
acudetox as an adjunctive treatment which should not be used as a stand-alone recovery
intervention.)

Researchers in Arizona (Bier et al, 2002) studied acudetox for nicotine dependent subjects (141).
At one month, 10% of subjects receiving acudetox only were not smoking as compared to those
receiving sham acupuncture along with education/counseling (22%) or those receiving real
acudetox along with the clinical intervention (40%).
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Integration and Sustainability

Applications and Outcomes
Integration with the Treatment Milieu
Integration at a Systems Level
The Acupuncture Interface
Acupuncture as “Innervention”
Program Sustainability

Available from the NADA Literature Clearinghouse: Smith (1993),

Acupuncture Helps Programs More Than Patients
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Applications and Outcomes
While originally discovered and developed as an adjunct intervention for acute opiate
withdrawal, the NADA protocol has since proved an effective tool across various addictions,
both substance and behavioral “process” type addictions, across different client populations, and
across the continuum of care. Over the last thirty years, NADA practitioners have found
acudetox helpful in treating persons dependent upon opiates, alcohol, cocaine, poly-substances,
marijuana, methamphetamine, prescription medication, as well as those addicted to acting out
with food, sex, gambling, etc.

The NADA protocol is not a stand-alone treatment. NADA’s experience with continued use of
the protocol in a variety of settings worldwide since the mid-1970’s confirms that the integration
of acudetox into addictions and behavioral health treatment programs generally improves client
retention, client and staff satisfaction, and program outcomes. Anecdotal evidence confirms that
acudetox generally facilitates the recovery process.
NADA Protocol within the Continuum of care/stages of recovery
Harm reduction, pre-recovery:
Programs typically offer acudetox as a support within harm reduction settings that focus on
health/safety, rather than on getting and staying sober. Examples of harm reduction programs
include needle exchange, outreach programs, HIV education, drop in centers, homeless shelters,
etc. Acudetox added to these programs often yields increased engagement and retention and
improved likelihood that persons will enter into some form of treatment. Even in setting for
which attendance and therefore treatment may be erratic, acudetox serves to move the person
towards a more proactive state.
Acute detoxification settings, including hospital based and other medically managed programs:
Detoxification programs typically offer frequent acudetox, at least once or twice daily. Some
programs offer one regularly scheduled group session and additional ear treatments delivered by
the clinical or nursing/medical staff as needed. Clients report decreased withdrawal symptoms
and craving, and use less PRN (as needed) medication. Clients are more likely to complete
successfully and graduate to the next level of care.
Hooper Foundation (Portland, OR) cited a decrease from 25% to 6 % in recidivism after adding
acudetox to their inpatient county detoxification program. Kent-Sussex (in Delaware) reported a
decrease in recidivism from 87% to 18%. Sleepmix tea helped to mitigate withdrawal symptoms
and improve sleep.
Early recovery settings, outpatient and inpatient/residential:
These types of programs typically offer frequent acudetox, daily or almost daily (5x/week)
especially if they offer intensive levels of psychosocial care. With acudetox, fewer clients leave
against advice. (AMA rates go down) and successful program completion rates go up.

The Portland Alternative Health Center/Portland Addiction Acupuncture Clinic (OR) reported an
overall program completion rate of 43.6%, as compared to 24% countywide in 1999. The
completion rate climbed to 71% for clients who also were placed in alcohol/drug free housing.
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Yonkers General Hospital (now Riverside Behavioral Health Center, Yonkers, NY) reported that
95% of clients found acudetox “helpful or very helpful”. Clinical staff reported clients had less
denial and were actively engaged in the treatment milieu. Clients who got acudetox moved more
quickly through stages.

Penn North Wellness Center (Baltimore, MD), an inner-city outpatient acudetox-based program,
documented that for 206 clients with prior criminal records and a documented average of 4.3
arrests/person, 97% had no new arrests in the five months after intake (an estimated average of
.37 arrests/person).
Maintenance/ongoing recovery programs:
Acudetox may be offered more or less frequently, as other psychosocial interventions vary
according to client need. Crouse Hospital (Syracuse, NY) counted 2700 acudetox treatments in
the year 2000 for methadone maintained clients. Acudetox recipients had 22% positive urine
samples as compared with 47% positive for the overall rate.

The NADA protocol can be offered on an as needed basis as part of relapse prevention planning.
Many acudetox programs offer the treatment as an ongoing support to graduate or “aftercare”
clients and encourage those persons to come for ear treatments whenever they may need
additional support or to get back on course if they do relapse.

NADA Protocol with Specific Addictions

(Based on clinical experience at Lincoln Recovery Center or observations of programs by the
authors unless otherwise noted.)

Opiate Addiction:

Lincoln Recovery Center began by treating opiate addiction in 1974 inspired by the work of Wen
with opiate addicted patients in Hong Kong. The NADA protocol, originally developed at the
Lincoln Hospital program, provides nearly complete relief of observable acute opiate withdrawal
symptoms in 5-30 minutes, and lasts for 8 -24 hours. The duration of the effect increases with the
number of serial treatments provided. Recipients often sleep during the session and may feel
hungry afterward. Patients who are acutely intoxicated at the time of treatment will behave in a
much less intoxicated manner after the session and report feeling gratified, in contrast to reports
of discomfort after Narcan administration.

In acute opiate detoxification settings, the NADA protocol is typically administered 2-3 times
daily. Alternatively, it can be administered only once per day along with Clonidine or Methadone
or other medication protocols on an outpatient basis. Many clients do well with daily needling
treatment because they taper their illicit opiate usage over a 3-4 day period. The addition of
acudetox to an opiate detoxification program typically leads to a 50% increase in retention of
completion of the recommended length of stay. Program retention is most strongly correlated
with treatment success.

Methadone maintenance:
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The NADA protocol can be integrated into a number of different methadone-assisted treatment
programs. Patients report a decrease in secondary symptoms of methadone such as constipation,
sweating, and sleep problems. Typically there is a substantial drop in requests for symptomatic
medication. Treatment staff usually notices decreased hostility and increased compliance in
acudetox recipients. The most important impact of acudetox in methadone programs is the
reduction of secondary substance abuse, usually involving alcohol and cocaine, even in patients
with minimal motivation (Margolin, 1993). Acudetox is effective with patients on any level of
methadone, buprenorphine or other medication protocol.

Methadone withdrawal is notable for unpredictable variations in symptoms and significant post-
withdrawal malaise. Acudetox helps clients to manage their fear and withdrawal symptoms and
increase their ability to participate in the psycho-social supports necessary to recovery.

Alcohol addiction:

Alcohol withdrawal can be life-threatening. Directors of the acudetox assisted social setting
detox program conducted by the Tulalip Tribe of Marysville, Washington estimate a yearly
saving of $148,000 due to decreased referrals to hospital programs. Inpatient alcohol
detoxification units typically combine acudetox and herbal Sleepmix tea with a tapering
benzodiazepine protocol. Patients report few symptoms and better sleep. Their vital signs
stabilize and they need less benzodiazepines. One residential program in Connecticut noted a
90% reduction in Valium demand when the herbal tea alone was added to their protocol.

Retention of alcohol detoxification clients generally increases by 50% when an acudetox

component is added to conventional settings. Some alcoholics receiving acudetox report a
resultant aversion to alcohol. Woodhull Hospital in Brooklyn reported that 94% of the patients in
the acudetox receiving group remained abstinent as compared to 43% of the control group who
received only conventional outpatient services. Bullock (1989) showed a 52% retention of
alcoholic patients receiving true acudetox, as compared to a 2% “sham” acudetox retention rate.

Cocaine addiction:

Acudetox recipients report more calmness and reduced craving for cocaine even after the first
treatment. The acute psychological indications of cocaine toxicity are visibly reduced during the
treatment session. The improvement is sustained for a variable length of time after the first
acudetox treatment. After 3-7 sequential treatments, the anti-craving effect is more-or-less
continuous with ongoing regular acudetox.

A study of cocaine-dependent methadone maintained patients receiving 8 weeks of acudetox

found a 44% overall abstinence rate. Abstainers reported decreased depression, a shift in self-
definition, decreased craving and increased aversion to cocaine-related cues (Margolin, 1993).

Urinalysis results at Lincoln Recovery Center for 226 cocaine and crack addicted persons who
had received more than 20 acudetox treatments found that 149 had more than 80% negative urine
screen tests for their entire treatment involvement and 39 more had at least 80% clean urine
results for the two weeks prior to data collection.
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Acudetox can lead to dramatic increases in treatment retention for cocaine addicted clients. A
program for pregnant, crack-using women in NYC, Women in Need, reported the following:

 . an average of 3 visits for conventional outpatient treatment only

 an average of 27 visits/year for acudetox along with conventional treatment

 an average of 67 visits per year for those who received acudetox, conventional treatment
and an educational component.

Methamphetamine addiction:

The NADA protocol affords a similar dramatic increase in retention for methamphetamine
addicted persons. Hooper Foundation, a public detoxification program in Portland, OR, reported
5% retention of methamphetamine users prior to the use of acudetox, and 90% retention after the
addition of acudetox. The program noted increased psychological stability and decreased
craving.

Marijuana addiction:

Primary marijuana addicted persons usually report a rapid reduction in craving and an improved
sense of mental well-being from acudetox. Secondary marijuana use is usually eliminated along
with the detoxification of the primary drug, e.g., cocaine.
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Integration with the Treatment Milieu

Integration at a Systems Level

THE ACUPUNCTURE INTERFACE

Some therapeutic processes transcend all treatment protocols and modalities. Acupuncture is
among these. We will review these processes to gain clinical understanding of the role of
acupuncture as a complement to them.

 Group. Group dynamics are a powerful therapeutic mechanism in recovery and establish
a ground for healing relationship. This dynamic is fundamental to our success with
acupuncture in this field. It provides an opportunity for group process, without
expectations placed on participants. The creation of a “safe group”, which for a
practicing addict is a contradiction in terms, creates a positive paradox as an introduction
to recovery.
 Intervention. Developed in Minnesota in the 1970’s, it is a process that involves
“significant others” in a carefully planned and orchestrated confrontation with the
“identified patient”. Admission to a treatment facility is made an ultimatum. The
concept of intervention is a major treatment breakthrough because it acknowledges the
addictive family system. A skilled intervention counselor will use the intervention as an
opportunity to heal the system itself.
Intervention is based upon the premise that the most endemic feature of the addictive
system is denial – it is the foundation symptom of alcoholism/addiction. Denial does not
necessarily refer to the use of the drug. Most addicts will admit to use. Clinical denial
refers to the consequences of the addictive use. “Hitting bottom” means that the
consequences of the chronic use have created the conscious connection between use and
consequences of use. At this point, denial can be broken. (Drug courts make use of the
opportunity of arrest to create a “bottom” for the addict.)

Acupuncture as “Innervention”

In our view of recovery, we always assume the motivation is present, regardless of the level of
denial, the identification with addictive behavior, or how fearful the patient is of letting go of the
addictive ground. There is always a deeper, wiser part of the person to which the intervention
speaks.

The acupuncture intervention/”innervention” invite the individual’s attention toward the inner
resources of healing.

Acupuncture can be seen as physical intervention on a level that addresses the core issue of the
disease of addiction.

Chronic drug use requires denial for its continued survival.

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It is virtually impossible to be accepting of, in touch with, and responsive to one’s body and
chronically use psychoactive drugs.

Acupuncture, as it has evolved in the public health/group setting with the NADA protocol has
the added potential of opening up the addictive system of isolated external energy. The Qi flows
outward, yin energy is nourished and is manifest in the room, and for the moment, the focus
shifts, and there is the possibility of the consciousness of unspoken connectedness and
participation.

 Relapse Prevention. Born, in part, by the failure of treatment as a result of its focus on
the detoxification and first 30 days of recovery. Clients often negotiate the early phases
of recovery successfully, only to relapse on release from the program or shortly
thereafter. Relapse prevention, as a focus, is also due to the increasingly sophisticated
research on the persistence, into abstinence, of the discreet alterations of
neurotransmitting mechanisms that result from drug use.

Alcoholism/Addiction is a disease characterized by relapse.

Phases of Recovery – Three General Phases of Recovery

 Transition
 Stabilization
 Empowerment

Acupuncture can be integrated with traditional treatment to enhance recovery at each phase.

Our experience with the NADA protocol has led us to go by a less “use specific” definition of
transition. Rather than a static event – abstinence, we emphasize the notion of recovery as
process. Our suggestion is that the transition phase begins with the consciousness of the
consequences of addictive drug use and extends for weeks, months or even years and is unique to
each individual. Transition is a scenario of balancing physical and emotional extremes. It is the
time required for the addict to become relatively comfortable with the idea of abstinence. It is a
period characterized by slips and starts.

 Detoxification/Acute Withdrawal. This is a subset of the transition phase, lasting from 3

to 15 days following abstention. Michael O. Smith MD calls it a “crisis in elimination”
and relates to the body’s homeostatic efforts to achieve balance in the sudden absence of
the chemical.

The recommended treatment for the detoxification period is daily auricular acupuncture
according to the NADA protocol.

The transition phase is a period of radical center-seeking. Clients weave in and out of many
different kinds of energy. Romantic honeymoon glows, periods of brooding, deep depression,
anxiety, grieving and fear may be present at any time. The time is characterized by great
emotional vulnerability and is a time when major life decisions are best avoided.
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In “Twelve Step” time it is the period of working the first three steps, which involve ego
dissolution, dethroning the king and discovering the meaning of the words powerlessness,
humility, surrender and gratitude. It is also a period of self-forgiveness. This is not a static
event, but rather a dynamic process. Patients must also deal with the disappointment that God
has not rewarded abstinence with “instant wellness”.

This period lasts about eighteen months following abstinence. One of the more harmful things
we can do is to make an inflexible blueprint of this period. Give people “markers”; assure them
that they are “right on schedule,” that it will get better if they don’t use. Making an issue out of
these time zones and “phases” is dangerous.

Counter transference – a projecting of our own hopes, fears, and expectations upon the client
who will then think they are doing something wrong because they think that, “by now, they
should be feeling thus and so.”

Honor and support this recovery process on every level. Validation of experience is essential.
“We are not bad people trying to become good; we are sick people trying to become well.” Also,
“we are not victims of addiction, but survivors of our life experiences.”

Acupuncture fills the experience-based gaps that exist in traditional treatment. It has the ability
to offer a fundamental validation of experience and the possibility of healing. It is physically
supportive, predictable, non-judgmental and validating. The client can access the experience on
his or her own emotional schedule.

One of the reasons that acupuncture needs to be daily, consistently, on demand, through the
transition phase, is so that the client may come into the clinic for treatment regardless of how
they feel that day, without fear of being judged, or of being asked to become cognitively engaged
in a conversation about how they are doing. This is “barrier-free” treatment.

It is after the completion of this transition phase that the full-body acupuncturist, at the client’s
request, may begin to provide more expansive treatment.

It is essential that the basic acudetox treatment continue to be available daily on demand so that
the program can be malleable to the client’s unique and changing needs, rather than becoming
dependent upon diagnosis for its success.

This is a new experience for the client, and for the drug treatment establishment in charge of
program evaluation. It is not new to the Twelve Step group, which says to the newcomer, “it
works if you work it.”

Ideally, there will also be crisis, referral or group counseling available “on demand.”

Counseling should mimic the barrier-free NADA protocol, in being supportive, non-judgmental,
and validating of experience.
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Caution should be taken not to expand prematurely into other emotional, social, and
psychological issues.

Eventually the client should become more and more centered in the Twelve Step recovery
program and weaned from the treatment program. This often occurs naturally. The treatment
program is never a replacement for recovery. An essential part of a good program is the design
and planning of structures that serve as supportive “bridges” out of the program and back into the
client’s community.

STABILIZATION PHASE
This phase commences with the onset of longer and longer moments of time in which the
individual is a last comfortable inside their skin with the idea of non-use of psychoactive drugs.
Typically this period begins with the client’s taking the 4th and 5th Steps and extends for three to
five years into recovery. There has been surrender.

In the stabilization phase, clients may sporadically return to the acupuncture clinic for “tune-
ups.” Secondary or “unmasked” symptoms and conditions will begin to be addressed. Major
career and relationship decisions are often made.

The sense of commitment to sobriety and sense of confidence that one is at last “out of the
woods” however makes the risk of relapse during this period high.

Acudetox continues to have a vital role, as well as the inclusion of therapy by other
professionals, particularly those involved with body work. Nutritional needs will begin to be
addressed. Secondary issues become primary – nicotine, eating disorders, sex addiction, or
relationship addiction. Psychotherapy may begin to play a role as the client becomes ready to
address family of origin issues. The family also may become involved in treatment. Unresolved
issues, untreated, may precipitate relapse. Women’s’, Men’s and People of Color type issues
also will surface and need to be dealt with in an empowering manner.

Clients will shift addictions along the way – to political, spiritual, or gender movements – a new
“fix” “out there.” If they are well supported enough to return again and again to their own
center, they may learn the way to true empowerment. They may come to appreciate that the
“path of excess leads to the palace of wisdom.”

EMPOWERMENT
This is the third phase of recovery. There are many “stuck points” in the shift from stabilization
to empowerment. It is the acceptance of ourselves for just exactly who we are. It is difficult,
also, in that every area of our society is saying the opposite, that we need to perform better, act
better, accomplish more, acquire more control, more resources and energy, look better, get our
lives together, set goals, lose weight, and aspire to be somebody at last. These are all things for
which all referents are outside.

Recovery doesn’t work in a vacuum. It occurs in the daily and moment-to-moment interface
with the addictive systems in which we must function. We are vulnerable to being seduced back
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into our addiction on a thousand levels – in every relationship, in every new memory of earlier
pain, in every enterprise, in every unmet childhood desire, etc.

It is not enough simply to be attending meetings, getting acudetox, having a sponsor, and
abstaining from psychoactive drugs and addictive behaviors. We must live in our recovery, in
our growth, in empowerment.

Based on Transformation and Recovery, Alex Brumbaugh, Santa Barbara: Stillpoint Press, 1994

See The NADA Protocol and the Serenity Prayer, by Shellie Goldstein (Appendix “H 4”)
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Long-Term Program Sustainability

By Alex Brumbaugh

The most important issues in acupuncture-based programs being sustained over time are
maintaining the foundation of the program while at the same time remaining flexible and
responsive to treatment and funding trends.

Foundation Maintenance:

Foundations are, by their nature, often beneath conscious awareness and attention. If a house has
a good and strong foundation, people can live in the house and do things in the various rooms for
many years and not be consciously aware of the foundation because it is “automatic,” or “built
in.” Little ongoing attention needs to be paid to the good foundation of a house because houses
are structurally static. Unless there are very severe external circumstances – such as termites,
earthquakes or floods – these foundations require a minimum of maintenance.

Treatment and recovery programs are structurally dynamic rather than static because of constant
shifts in staff, client base, and funding. The influx of new staff, new philosophies, and new
funding imperatives requires that sustained attention be paid to the foundation of the program.

The architect Frank Lloyd Wright developed the concept of a cantilever foundation for tall
buildings. Intended to make the buildings earthquake-resistant, a steel cantilever was driven
deep in the ground, and from its vertical projection the building was suspended like branches
from the trunk of a tree. Walls no longer had to depend upon corner beam supports, therefore
freeing space for creative design. Wright believed that if the cantilever foundation went deep
enough into the earth, there was no limit on how tall the building could be. If an earthquake
came, the supple building would bend and sway like a tree in the wind but would never break.

NADA treatment programs, in their traditions and spirit, are safe; accessible; welcoming; barrier-
free; “user-friendly,” and client-centered. These organizing principles serve the program as the
cantilever foundation serves a tall building. If these things are firmly in place and deeply
honored, the program can easily withstand outside influences and dramatic changes in funding
and staffing.

Sometimes we become so accustomed to hearing about these foundation principles that they
become clichés or hollow phrases, and their meaning can be forgotten or taken for granted.

“Safe” means that it is okay for the client to be there. Some programs even have guards at the
doors to assure the safety inside. The program serves as an oasis or safe haven in contrast to the
environment in which the addict has to function outside.

“Accessible” has meaning in terms of geographical location, and programs can better serve
clients if they operate in the neighborhoods where the clients live, but it also means that the
program is emotionally and psychologically accessible. There is no discrimination or judgment
made about clients based upon class, race, gender, sexual orientation, or ethnicity. Nor is there
discrimination based upon the particular circumstances that brought the client to treatment. The
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fact that the client is involved in the criminal justice system, for example, is quite incidental to
the client’s being an addict or alcoholic.

“Welcoming” means that the program is as interested in common decency toward individuals as
it is in therapeutic outcome. The client is respected as if a guest in ones home or a customer in
ones store. In homes that are welcoming, and in stores that are successful, the guest/customer is
“always right,” and the host is honored and graced by the guest’s or customer’s presence.
Addiction is a disease of isolation, of being “outside.” A proper and genuine welcome into the
recovery circle is so important that, for many clients, it may be all that is required for success!

“Barrier-free” means that there are no “hoops” to jump through or interviews or assessments
that the client needs to endure before something significant happens. The barrier-free
acupuncture clinic as a “front-end” service provides this.

“User-friendly” means that the program is relapse tolerant. It understands that the nature of
addiction is that people use drugs. Programs that have daily urine testing have a distinct
advantage in this regard. For programs that don’t, each counselor and acupuncturist must be in
the ongoing process of examining their own reaction to a client’s use episode. The important
thing is not that the client used, but that they came back.

“Client-centered” means that the client is free to negotiate stabilization in their recovery on
their own schedule rather than on the program’s schedule. It means that clients are met where
they are and not where the program thinks they should be. Acceptance is the hallmark of
recovery, and a program’s capacity to accept clients exactly where they are and to respond
intelligently to that gives the program an opportunity to model recovery.

A program that embraces these as the organizing principles of its deep foundation will be very
likely to sustain itself and grow.

There are three other intrinsic features of the NADA acupuncture modality itself that make it a
foundation for other services, and it is important to program sustainability that these be kept in
the consciousness of the program’s clinical and administrative staff. In preface to describing
these three elements, a question we might ask is, “what can we possibly do in the design of our
services to make them ‘competitive’ with the things we are asking our clients to give up?” In
other words, what can we offer in the structure of what we do that can compete with, or replicate
in a positive way, or mirror the things that our clients are doing outside at a level that will attract
their attention, engage them, and retain them long enough for something significant to happen?

Retention, as will be discussed in more detail below, is the central and most important concern of
all chemical dependency treatment. We know anecdotally, and through research and outcome
studies, that if we can retain clients in treatment long enough for something significant to happen
for them, then they have a chance of achieving and maintaining recovery. If we cannot, their
chances of achieving and maintaining recovery are very slight.

Some programs offer psychoactive drugs as “replacement therapy,” and this helps achieve the
goal of attracting the attention of clients, of engaging them, and of retaining them. Indeed, the
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literature of drug treatment is largely a discussion of drug therapies, and these therapies, such as
methadone, do in fact have the ability to compete with, replicate, or mirror some of the things
that clients are expected to give up. Methadone programs have reasonable retention rates.

But programs that elect not to rely on drug replacement therapy must rely on other services to
achieve these goals. The most obvious service used in conventional programs is “talk therapy.”
There are many different modes of talk therapy. Perhaps the most potent mode in early recovery
is “disclosure” or peer support, which is the primary therapeutic mechanism of 12-Step
programs. Some counselors who are themselves in recovery use this mode, and some programs
use peer counselor and support groups. Education is another classic talk therapy mode in
chemical dependency treatment, giving disease and about drugs, self esteem, family dynamics,
and so forth. Another powerful mode is relapse prevention, providing the client with skills and
tools to avoid the stresses that precipitate relapse. Another is case management, which is the
often essential process of connecting the client with ancillary services. Finally, there is
individual or family counseling or psychotherapy, which is generally essential in long term
recovery.

None of these diverse modes should be disparaged or discounted. They are vital and diverse, as
the rooms in a house. They are the point of having a foundation. It is in these various modes
that the “something significant” can happen that makes long term recovery possible.

And yet these modes do not contain, either singly or collectively, the inherent deep structure that
are necessary to have consistent success in attracting the attention of clients, of engaging them,
and of retaining them for reasons we will describe.

There are three ways in which the acupuncture modality provides these deep structures.

1. Acupuncture provides consistency.

The first foundation element of the acupuncture modality is its unique ability to provide
consistency. Chronic alcoholics and drug addicts crave consistency. This may seem a paradox
in that their lives are generally characterized by inconsistency and unpredictability, but this is the
very reason that they crave consistent experience. They seek and find this consistency in their
drugs. Often, their drugs and the mental and emotional states they elicit are the only consistent
thing in their lives. In the beginning of their use, they were perhaps motivated by novelty-
seeking, but in the later or chronic stages they are far more interested in consistency, which is
evidenced by how particular and meticulous alcoholics and addicts generally are about the brand,
supply, dose, and strength of their drug(s), their synergistic effects, and so forth. A primary
reason for this is that the motivation to take drugs in the chronic stage is in the amelioration of
the symptoms of acute withdrawal. Chronic drug users are going through detoxification every
day, whether they are in treatment or not, and they are engaged in the daily, methodical, and
formidable task of masking and suppressing the discomfort of the symptoms of acute withdrawal
with more drugs. This requires a fairly high degree of precision, attention, and consistency in
dose-response.
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The acupuncture modality we use has the ability to provide this consistency of experience and
hence to replicate or mirror in a healthy way an important element of what we are asking them to
give up. The talk therapies that programs provide, as rich and diverse as they may be, cannot
provide this level of consistency since they are dependent to one degree or another upon the
personality and skill and style and even the mood of the person delivering the service.

The treatment effects of ear acupuncture, on the other hand, are relatively predictable and
consistent independent of the acupuncturist who is delivering the treatment. The treatment is
generic, and does not vary significantly based upon presenting symptoms or diagnosis. While
the technique and strategy of choosing ear point location may vary slightly among different
acupuncturists, the treatment experience is largely comparable to the last treatment, to the one
before that, and so on. This consistency is supported by offering the treatment at the same time
every day.

This element provides a horizontal flexibility parallel to a 12-Step meeting, from which a
participant can gain a predictable benefit regardless of the stage or phase of recovery that they
happen to be in, and it is a benefit that is independent of the personality of the therapist.

2. Acupuncture works in the present moment.

Most alcoholics and drug addicts are oriented toward living in the present moment. It is usually
difficult for them to realistically project the consequences of actions into the future, or to relate
present circumstances as being a consequence of past actions. The past in general is too painful
to entertain, and while many alcoholics or addicts may have frequent reverie or fantasy about the
future, they are usually not oriented toward realistic planning for the future. This is one reason
why the 12-Step cliché of “one day at a time” is fairly easy for alcoholics and addicts to identify
with.

Psychoactive drugs operate in the present moment. It is for relief in the present moment that
alcoholics and addicts ingest drugs.

While psychotherapy seeks to operate in the present moment through accessing current feelings,
much talk therapy in the stabilization phase of recovery – the first six months – is limited to the
past and the future. Examples are, “How old were you when you first started using drugs?” or
“How did it make you feel when that happened?” or “Can you think of some things you might do
differently if that situation happens again?” etc.

For people to be able to function in relation to past and future, they need to have the capacity to
be in the present. If they have no comfortable “place to stand” in their present experience, they
are not likely to be able to work constructively with past or future issues.

Acupuncture operates in the present moment. It does not operate on a linear or horizontal plane,
but on a vertical one, directing the attention inward toward the sources of healing. Michael
Smith has stated that the goal of this therapy is not that people get well, which is unrealistic, but
that they get better. In other words, while it is not likely that the acupuncture will alleviate all of
the symptoms of acute or post acute withdrawal that the person is experiencing, it may give them
enough hope and strength to make that discomfort endurable. If successful, they will reduce use
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and return tomorrow. Because, if we can offer them something that makes them feel better in the
present moment without drugs, we will have given them something that they may not have
experienced in many months or even years, and this is something to which they are likely to
return.

3. Acupuncture is a ritual experience.

Addictive drug use is an experience surrounded by ritual. Each drug has its own culture and its
own rituals that govern the procurement, preparation, and ingestion of the substance and the
paraphernalia that is used. If one speaks with a newly recovered alcoholic or addict, one might
even conclude that the person is as “hooked” on the rituals attending the use of the drug as they
are on the effects of the chemical itself. Much relapse prevention work is indeed directed toward
the rituals surrounding drug use that become, in recovery, relapse triggers – the “people, places
and things” associated with the use of the drug.

One function of rituals is that they give meaning to life, and we live in a culture that is lacking in
ritual experience. Indeed, one of the reasons that people, especially young people, may be so
attracted to addictive or “drug” cultures is the element of ritual or “life meaning” that attends
these cultures. When an individual is faced with the prospect of giving up addictive drug use,
they are also faced with giving up the attending rituals with which they may have formed a
primary identification. Effective treatment must be structured to help provide ritual alternatives
to compensate for this loss.

12-Step programs achieve this compensation for many people. Attending a 12-Step meeting is a
ritual experience. The meeting always begins and ends, without deviation, with the same words
spoken and the same formalities. The words spoken at the opening of the meeting are an
invocation for what is to follow. The invocation creates, within the meeting, ritual space in
which healing can occur. Indeed, another principle function of ritual is to invoke an opportunity
or “space” for healing, for transformation, or for spiritual experience.

Coming for acupuncture is a ritual experience. The tea is part of this. More important is the
design of having the client do for themselves everything that they possibly can, such as signing
in, getting their won treatment card, selecting their needles, opening the packet, prepping their
ears, and taking their own needles out at a mirror following treatment. As one can readily
observe in the acupuncture clinic, all of these things are quickly learned, adapted, and seriously
undertaken by the client as a part of a recognized ritual. And, as is the case with the 12-Step
meeting, these repetitious behaviors invoke the “content” of the treatment experience which,
again, gently directs the attention away from external or linear matters and inward toward the
sources of healing and transformation.

In these three ways, the deep structure of our acupuncture treatment modality has elements that
help attract the attention of clients, engage them, and retain them in treatment. It therefore
provides a foundation of recovery that greatly enhances and enriches the other diverse modes of
service that programs offer. It provides clients with something recognizable, personal,
meaningful, and consistent to which they can return at any time regardless of how they are doing
in other areas of their lives or in other parts of the program.
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All of these foundation elements of NADA programs can be threatened in at least three ways:

1. In busy clinics, over time the acupuncture can tend to “disappear” from consciousness
and be taken for granted. If administrators, counselors and other staff begin to take the
acupuncture service for granted and fail to provide support for the acupuncturist during
clinic, the ambiance of the clinic can rapidly deteriorate. The acupuncturist requires the
support of at least one other dedicated counselor or clinic monitor for every ten clients to
assist with sign-in, intakes, safety issues, tea, noise level, and the emergent concerns of
clients. The ratio of one acupuncturist to 24 clients in an hour should also be diligently
followed.

2. If the program places a condition on clients receiving acupuncture, such as participating

in groups or other treatment services, then the treatment is no longer barrier-free, and
clients who are not emotionally ready for other program services will generally drop-out.
One of the cardinal strengths of acupuncture is in making treatment accessible, and any
conditions the program places on the service threatens this accessibility. Programs may
be tempted to do this because of funding or billing imperatives, or because they are
impatient with the length of time it may take some clients to begin to access other more
cognitive treatment components.

3. If the acupuncturist enters a diagnostic relationship with the client prematurely and
expands the 5-point auricular protocol, some of the deep structures that make
acupuncture the foundation are compromised.

 The treatment is no longer consistent, and now depends upon verbally engaging the
client in diagnostic transactions. If good benefit is achieved, the client may return the
following day expecting similar results, which may not be realistic.

 A relationship and hence bonding will occur in the diagnostic process between the
client and the individual acupuncturists, creating the opportunity for dependence of
the client upon the therapist for sustaining his or her recovery rather than upon a
therapeutic process guiding him to inner resources. This can be especially disruptive
if the program employs several acupuncturists.

 While experientially, the treatment itself will still function in the present moment, the
diagnosis that precedes the treatment will require accurate historical information on
the part of the client, shifting the therapeutic process from vertical to linear
transactions. And, while the skilled acupuncturist may develop the level of trust
necessary for accurate diagnosis, that trust depends upon interpersonal verbal
exchange, and the systemic value of a non-verbal treatment opportunity is lost. It is
important to realize in this regard that for the newly sober client, relapse is a
“statistical inevitability,” and the clinician must evaluate the impact of individualizing
treatment upon potential relapse and, most important, upon the client’s psychological
ability to return to treatment following a use episode.

 Finally, the ritual associated with the repetitive auricular acupuncture experience has
been lost. Even though the treatment itself may invoke ritual healing space for the
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client, addicts are a neurologically and emotionally sensitive population, and “simple
is better” until stabilization is achieved. A safe, predictable, and simple container for
ritual experience is better in the beginning as a balanced response to the paradoxical
presentation of both Excess and Deficiency in chemical dependency clients.

Flexibility and Responsiveness to Funding Trends

Once these foundations are secure in the awareness of program staff, the program can be creative
and flexible with other program elements. It can add things, trim things, experiment with on-site
vocational rehab or innovative mental health programs, enter collaborative relationships with
disparate agencies, expand into new client arenas, add smoking cessation programs, and so forth.

Nothing in the chemical dependency field seems static at the present time. There are dramatic
shifts in the channels through which funding happens. Future funding is apt to arrive less
through conventional channels and more through departments of education, housing, criminal
justice, and social services. Each of these venues requires that the program be able to “speak
different languages” to respond to different perceptions of need. A competent and sustained
program will be able to interface as effectively with school superintendents as with public health
officials, or with probation officers as with the welfare case manager. Leaders in the program
are challenged to cultivate the breadth of understanding and flexibility necessary to respond to
these shifts without losing the deep foundation of what their program does.

Survival in the current funding environment also challenges us to be able to translate what we do
into verifiable treatment outcomes and milestones. As funding shifts, so do outcomes and
milestones. For one funder, employability is the significant outcome; for another it is housing;
for another it is a reduction in crisis mental health services, or better grades in school, or a
reduction in criminal behavior. We need to be able to track client progress along a multitude of
lines while at the same time politely educating funders that, for addicts, all of these domains are
secondary to sustained sobriety. While we know that people who achieve and sustain sobriety
invariably seek improved vocation, permanent housing, utilize fewer public services, and so on,
we need to improve our skill at tracking these secondary benefits in objectively verifiable ways.

Acupuncture lends itself well to the new outcome funding environment, particularly in the
critical stabilization phase of recovery. The premier cause of relapse and treatment drop-out is
the program’s failure to adequately address the physical symptoms of acute and post acute
withdrawal. Many conventional treatment programs have no therapies in place at all to respond
to these physical symptoms. A program’s rich array of educational, counseling, and case
management services and comprehensive video library will be of little avail if the client is
experiencing a cycle of acute craving and anxiety. Programs that cannot retain clients in
treatment during the early relapsing phase will not have good long-term outcomes, and the key to
that retention is the program’s ability to respond to these inevitable and persistent physical
symptoms.

Therefore, a fundamental stabilization milestone is that “the client self-reports relief from the
symptoms of acute and post-acute withdrawal.” It can be easily shown through client tracking
that success in this milestone correlates with success in the subsequent milestone of program
retention: “client remains in treatment at (30/60/90) days and continues to comply with treatment
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plan.” And, the one thing we know for certain from chemical dependency research is that the
longer the client can be retained in treatment, the better the long-term outcomes, whether primary
or secondary.

The only method besides acupuncture for achieving this first critical milestone is drug therapy.
Indeed, drug applications such as buprenorphine for opiates, Prozac (buproprion) or generic
imiprimine for cocaine and amphetamines, and Naltrexone or phenobarbital for alcohol, are
gaining increased acceptance in outpatient programs. This approach requires medical
supervision, however, which adds dramatically to the cost of services. Acupuncture-based
programs, therefore, who have cultivated the capacity to track these milestones, are well-
positioned to compete in this new outcome-funding environment.
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The NADA Protocol and the Mutually Supportive Peer Fellowships.

Since the initial days at Lincoln, NADA has always encouraged acudetox clients to engage in
mutual support fellowships. Treatment, even acudetox-based treatment, represents a finite
intervention, while recovery from addictions represents a life-long process of growth and
transformation. As always, NADA recognizes that acudetox is not a stand-alone treatment.
Active engagement with a community support system increases the likelihood of long-term
sobriety.

There are many different support fellowships. Different communities have different offerings
and clients will have to find the groups whose philosophy, content, and style best suit their
needs. The important components are accessibility, availability, relevance and accountability.
Almost all communities around the world have fellowships patterned after the 12 step model
developed by Alcoholics Anonymous (AA). AA offers not only a rich and ready support system
but also an outlined path for living, the 12 steps. Other 12-step groups include, Narcotics
Anonymous, Nicotine Anonymous, Al-Anon, Nar-Anon (for persons associated with alcoholics
and addicts respectively), Co-Dependents Anonymous, Overeaters Anonymous, Gamblers
Anonymous, Sex and Love Addicts Anonymous, Workaholics Anonymous, etc. Other, non-12
step examples of support groups exist, such as Rational Recovery.

Alcoholics Anonymous:
“Alcoholics Anonymous® is a fellowship of men and women who share their experience,
strength and hope with each other that they may solve their common problem and help others to
recover from alcoholism. The only requirement for membership is a desire to stop drinking.
There are no dues or fees for AA membership; we are self-supporting through our own
contributions. AA is not allied with any sect, denomination, politics, organization or institution;
does not wish to engage in any controversy, neither endorses nor opposes any causes. Our
primary purpose is to stay sober and help other alcoholics to achieve sobriety.”
Copyright © by The A.A. Grapevine, Inc. www.alcoholics-anonymous.org

The 12-Steps

While the concept of the twelve-steps began with Alcoholics Anonymous, most fellowship
groups for addicted populations have adapted these tenants for the specific addictions. The
following are the steps for addictions in general:

1. We admitted that we were powerless over addiction, that our lives had become
unmanageable.
2. We came to believe that a Power greater than ourselves could restore us to sanity.
3. We made a decision to turn our will and our lives over to the care of God, as we understood
Him.
4. We made a searching and fearless moral inventory of ourselves.
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5. We admitted to God, to ourselves, and to another human being the exact nature of our
wrongs.
6. We were entirely ready to have God remove all these defects of character.
7. We humbly asked Him to remove our shortcomings.
8. We made a list of all persons we had harmed, and became willing to make amends to them
all.
9. We made direct amends to such people wherever possible, except when to do so would
injure them or others.
10. We continued to take personal inventory and when we were wrong promptly admitted it.
11. We sought through prayer and meditation to improve our conscious contact with God, as
we understood Him, praying only for knowledge of His will for us and the power to carry
that out.
12. Having had a spiritual awakening as a result of these steps, we tried to carry this message to
addicts, and to practice these principles in all our affairs.

See Appendix “H 3” for more information on AA.

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Oriental Medicine in the Context of

Addictions and Behavioral Health
Treatment
Introduction to Oriental Medical Concepts
Oriental Medicine as Related to Behavioral
Health and Recovery
“Empty Fire”

Some people have found the following to be accessible introductory

texts: The Web That Has No Weaver, by Ted Kaptchuk, Between
Heaven and Earth, by Harriet Beinfield and Efrem Korngold, and Voices
of Qi – An Introductory Guide to Traditional Chinese Medicine, by Alex
Holland.
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Oriental Medical Concepts

Qi

Most ancient healing arts understood that all living things were greater than the sum of their parts
and one of the key components that support this understanding is the concept of ki, prana or elan
vital. In Oriental medicine this intangible substance is known as qi or chi (pronounced “chee”)
and can be viewed as the intangible part of the person that empowers the being and makes each
individual unique. Oriental thought also does not separate the person into body, mind and spirit
but rather considers the person in his or her entirety or wholeness.
The ancient texts describe many types of qi and state that the different forms travel within or
along pathways known as meridians. Some of these pathways connect with the organs that are
themselves described in physical, emotional and spiritual terms. For example the heart, while in
modern medicine is seen as solely as a blood pump, in Oriental medicine is said to be the seat of
the person’s mind and home of his or her spirit.
Qi is also responsible for giving us the ability to be animated. However, qi is not what causes
movement or powers movement because qi can’t be separated from the movement itself.
Similarly, qi is what allows us to grow and mature and it is growth and maturity as well.

Health and Disease

In Oriental medicine health and disease are also manifestations of qi, or more accurately how the
qi is traveling within and along the meridians. When a person’s qi is flowing smoothly and
appropriately the person is said to be in a state of wellness. When the qi is obstructed or out of
homeostatic balance in some way, dis-ease occurs. Oriental medicine uses interventions –
acupuncture, herbal medicine, tai chi, qi gong, nutritional and lifestyle recommendations, tui na
(medical massage), etc. –to restore harmonious qi flow so that healing on all levels of the
person’s being becomes possible.

Yin and Yang

One way of observing the manifestation of qi in a person is via yin-yang theory. This Oriental
medical model of inhibiting and activating forces translates literally as the dark and light sides of
a mountain. Yin and yang are considered opposite yet interacting relative realities and one
cannot exist without the other. We only know that the side of the mountain on which the sun is
shining is light because we have experienced darkness on the other side and vice versa. We
understand these things in relationship with and relative to each other. Hot/cold, male/female,
inside/outside, movement/stillness, health/disease, and addicted/recovered only exist because we
know of the other opposite interrelated manifestation.
Everything in the universe has yin and yang components because everything in the universe
exists in relationship to everything else. There are no absolutes. Things can be relatively more
or less yin or more or less yang relative to something else. For example, compared to noon, dusk
would be considered less yang (less light) while at the same time being relatively less yin than
midnight (not as dark). On the other hand, dusk is also relatively more yang than midnight.
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It is also said that yin and yang transform into each other. As we go past midnight and continue
into dawn, we see yin slowly transforming into relatively more yang. Likewise as noon becomes
dusk and dusk is followed by evening we see yang transforming into a relatively more yin state.
The same holds true with the seasons – winter to spring to summer to fall and back to winter –
ever transforming into relative levels of yin and yang.
The yin-yang or tai chi symbol embellishes all of these concepts in that we see the relatively
lighter side, the relatively darker side as well as the mutual interdependence upon and
transformation into each other. Note also the light and dark “eyes” within the maximal yin and
yang components representing the fact that there is always a bit of yin in every yang and vice
versa.
Because the manifestation of qi in the body can be described in
terms of yin and yang, it follows that wellness is dependent upon an
appropriate balance of yin and yang and yin and yang-like
activities. In general, yang has to do with movement and doing
while yin is concerned with stillness and being (think back to the
light and dark sides and the activities in nature these two states
induce). Constantly being on the go or under “stress” (yang)
without proper rest and nourishment (yin) undoubtedly will lead to
disease due to imbalance. On the flip side, being a coach potato
(yin) without getting out into the world (yang) can be just as
detrimental to health because of the imbalance in the other directions.
Yin versus Yang

While all things exist in relation to each other, activities and states of being can generally be
assigned as relatively more yang or relatively more yin. Following are examples of each state:
YANG YIN YANG YIN
Light Dark Hot Cold
Full Empty Male Female
Scattered Dense Heaven Earth
Upward Downward External Internal
Outwards Inwards Lateral Medial
Fire Fuel The “High” The Drug
Doing Being Active Passive
Forceful Calm The Mind The Brain
Expend Accumulate Faster Slower
Energy Matter Acute Disease Chronic Disease
Wakeful Sleepy Reason Intuition
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The above list also indicates that anatomical directions also have yin and yang correspondences.
Humans are considered the vessels between heaven and earth. Therefore, towards the head
(superior anatomical direction) is considered yang relative to the feet (inferior direction) that are
considered more yin. Towards the periphery of the body (lateral direction) is considered yang
relative to the medial inner core of the body (relatively yin). Regarding the ear, the depressions
(the fossa and concha areas) are considered yin relative to the raised surfaces since the
depressions are closer towards the body’s core. Dark depressions are also relatively more yin
than raised surfaces.

Addictions/Behavioral Health and Empty Fire

Modern culture is one that tends to be external and aggressive: yin fueled, yang-like activities
such as intense stimulation, competition, caffeine consumption, etc. Little time is spent
replenishing this lost yin, leading to a condition known as yin xu (yin deficiency) that often
results in mental restlessness, agitation, troubled sleep, and the like. While these manifestations
appear to be due to excess yang, they are actually symptoms of the underlying phenomenon, the
deficient yin in a condition referred to as empty fire. In other words, while symptoms and
behaviors appear to be from too much yang, there is most likely a deficiency in both yin and
yang. It is because the yin is much more depleted that the yang appears to be in excess. Without
the solid, firm grounding the yin provides the yang-like symptoms flare up, thus the term empty
fire.
Addiction, by its very nature, also consumes vast amounts of yin. In addition to that which is
consumed by the substances and behaviors themselves (for example, cocaine or gambling),
individuals challenged by their relationships with addictive substances generally live lives filled
with violence and abuse and are in states of fear and denial. Without the yin to balance the yang,
symptoms that appear to be from an excess of yang arise (aggression, anger, increased violence).
Yang behavior is not the true problem, however but merely a symptom of the underlying
deficiency. Not liking the effects, the individual then continually repeats his or her behaviors in
an attempt to self medicate (e.g. drink more, rationalize, obsess, etc.) which further depletes yin
and a dangerous spiral ensues. More substances or behaviors are required to provide the same
level of comfort, a phenomenon known as tolerance in modern medical terms.
Often society tends to respond to these individuals with force and or control such as locking
them up in jail or prison. Under restriction, he or she fights back, a yang-like activity, which
further increases the disparity between yin and yang.
Therefore the key to successful treatment for substance abuse lies in being able to nourish yin –
to put a firm foundation back under the individual – both in the personal and social realms.
Treatment should provide a means for the client to gain knowledge of personal needs by
providing the ability to have an internal experience. This internal experience will, in turn, build
the internal structure many of these individuals lack so that healing can take place on a firm
foundation.
There are many ways in which individuals can nourish their own yin but few people have the
self-discipline to do so on their own, at least initially. Persons in early recovery generally lack
the necessary ego-strength to practice meditation, yoga, tai chi or self-healing practices
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effectively. In essence they lack the initial inner strength to attain inner strength and often
become frustrated at the lack of progress.
It is imperative, therefore, that aspects of addictions and behavioral health treatment be yin
nourishing. This is true of the environment, the interactions during treatment and the treatment
itself. The NADA acudetox protocol provides a simple, minimally interactive modality that
allows for internal experiences beyond those which clients can experience on their own.
Acudetox uses the ear, associated in Oriental Medicine with the energetic Kidney, and specific
yin points in the ear, the Heart (Shen Men), Kidney, Liver and Lung to contact, nourish and
strengthen the yin as well a yin-like treatment experience. As the yin develops so will the client’s
ability to go deeper inside. It is important not to minimize or distract the client from his or her
right and need to experience painful feelings, an essential part of healing. Yin nurturing
treatment includes holding the space for the client, providing structure and a safe environment
while helping to foster a spirit of discovery and curiosity about feelings, thoughts and beliefs.
Successful healing must begin at this deep, inner level.
Acupuncture – Physiological Mechanisms of Action
Researchers have noted the following variety of specific physiological effects associated with
acupuncture as cited in Brewington (1994). It has been reported that acupuncture at traditional
points produced dramatic effects in EEG, GSR, blood flow, and breathing rate, while stimulation
by needle placement in placebo points produced no appreciable effects. Various studies have
linked acupuncture to the production of endogenous opiate peptides, such as beta-endorphin and
metenkephalins. Acupuncture has also been related to changes regarding other neurotransmitters,
including ACTH and cortisol levels, serotonin and norepinephrine and 5-HT. Research linking
endogenous opiate peptide (EOP) production to optimal immune system functioning concluded
that acupuncture appears to have beneficial effects on the immune system.
Certain medications – namely methadone, corticosteroids, and benzodiazepines – seem to
suppress part of the acupuncture effect. Patients taking these medications in substantial quantity
have clearly less relaxation effect during treatment and seem to have a slower response to
treatment. Nevertheless, acupuncture is an effective treatment for secondary addiction in high
dose methadone patients. Acupuncture is widely used to treat adrenal suppressed patients who
need to be weaned off cortico-steroid medication.
Acupuncture effects have been documented in a wide range of organisms. Needling the stem of
plants at low resistance pint will correlate with a rapid increase in the temperature at the tips of
the leaves as measured by thermography. Needling a point of normal resistance will produce no
such effect (Eory 1995). It seems clear that acupuncture involves the primitive and pervasive
functions that are common to all life. Such functions include circulation on a microscopic level,
homeostasis, wound healing, immune function, and micro-neurological function. It has an impact
on the autonomic nervous system, which is an example of a relatively primitive and homeostatic
system in human beings.
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Client Management Issues and Strategies

Special Populations: Understanding Needs and
the Role of the NADA Protocol
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Specifically defined populations

Programs find the NADA protocol particularly helpful in meeting the special needs of groups
such as adolescents, elderly, women, culturally defined populations, gay/lesbian/bisexual and
transgender clients, criminal justice-involved clients, homeless and/or job-less clients, veterans
and clients with co-existing disorders including HIV/AIDS, hepatitis, mental health concerns,
chronic pain, domestic or other violence, and trauma survivors. These populations tend to have
more trouble getting and staying clean due to additional complications and stigma. Generally,
programs that target special populations offer clinical and/or medical interventions specifically
designed to address the unique needs of that group.

For example, adolescents in California reported that acudetox not only supported their recovery
from alcohol and drug addictions, but also made it easier to study and focus in school. Clients
with co-occurring HIV/AIDS and/or Hepatitis report better overall general health when receiving
the NADA treatment. Programs often encourage or offer full body acupuncture and herbal
medicine to address viral induced symptoms as well as medication induced symptoms.

The NADA Protocol for Women and Children

The number of women, including child-rearing and/ or pregnant clients, in addictions and
behavioral health treatment programs has steadily increased. Women need treatment that
addresses their particular needs as women, and can be arranged around their child-care
responsibilities. Lack of safe childcare, as well as cultural barriers such as greater societal stigma
around addictions, creates barriers to entering treatment.

The stigma is really intensified for women who are pregnant. Some states have even gone so far
as to prosecute or mandate treatment for women who use drugs while pregnant. Acudetox has
proven to be a very effective intervention with this population, which is particularly significant
because other, medication-based forms of treatment are not appropriate and/or available to
pregnant women. The use of acudetox led to a considerable expansion of treatment services for
cocaine and crack using women.

Perinatal programs ideally provide combined prenatal care, parenting skills education and
support, along with addiction treatment. Lincoln Recovery Center has offered a specialized
maternal program since 1987, and has been treating more than 100 pregnant cocaine users per
year. Women bring their infants and small children to the clinic. Typically, the young mother
will sit with a baby in her lap during the ear needling treatment. The acudetox provides
relaxation and reduction of stress. Frequent supportive counseling sessions replace the
confrontations that are typical of some other drug-free programs. Mothers who must bring
children or make child care arrangements often need flexible scheduling for counseling and other
appointments.

Lincoln clients have regular visits with a nurse-midwife and receive specific education and
counseling relative to pregnancy and child-care. The Lincoln program was cited as a model
innovative program for prenatal care in a monograph, "Hospital and Community Partnership"
issued by the American Hospital Association in 1991.
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The average birth weight for babies at Lincoln with more than 10 maternal visits is 6 pounds 10
ounces. The average birth weight for less than 10 visits is 4lbs 80z, which is typical of high-risk
cocaine mothers. There is a high correlation between clean toxicologies, retention in the clinic
program, and higher birth weights. 76% of pregnant women are retained in long-term treatment
and give birth to non-toxic infants.

Premature birth is a serious health risk. The Hospital of St. Raphael in New Haven has been
using the Lincoln acudetox model for many years. The director of obstetrics, Dr. Wilfredo
Reguero, reported a drop in perinatal death rate from 18.5 to 7.1 from 1990 to 1992, following
the use of the NADA protocol and other innovative outreach techniques. Special acudetox-based
components have also been developed for women with children in long term foster care in the
Drug Strategies Institute program in Baltimore.

There are a variety of other treatment settings around the country utilizing the NADA protocol in
maternal programs across the full continuum of care. These include inpatient facilities and
halfway houses that take women with their children, outpatient and day treatment programs.
Particularly innovative is the BASICS program in Minneapolis/St. Paul, Minnesota that utilizes
an Acudetox Specialist (ADS) as a member of multi-service treatment team providing home
based services.

Vital to the success of any maternal substance abuse program is helping the woman to become
drug-free for herself, not just "for the sake of the baby". A person who appreciates her own value
will be a better parent and is better able to refuse drugs and drug filled relationships. It is also
important for the program to understand the woman as more than a "fetal container" and
therefore not abruptly terminate services after delivery.

Most addicted women also bring to treatment their experiences of trauma including violence,
sexual abuse, rape, etc. Female clients are often trapped in destructive and exploitative
relationships and therefore may have special difficulty with any therapeutic relationship. A
consistently tolerant and non-confrontational approach prepares the way to establish a trauma
survivor support service for patients at an early sobriety stage of recovery. The supportive
atmosphere makes it relatively easy for clients to keep children with them during treatment
activities. The acupuncture point formula used for substance abuse is also specific for the kind of
emotional and muscular guarding associated with early sexual trauma. These clients will suffer
intermittent crises and experience profound challenges to their physical and spiritual identity. All
of their relationships will be strained and transformed. The NADA protocol is very appropriate
adjunct to trauma survivor's support work.

There is some indication that women are most vulnerable to relapse in the luteal phase (the last
14 days) of their menstrual cycle. Some programs especially encourage women to return for
relapse prevention acupuncture treatment around day 18 of their cycles.

Some programs provide services for both adults and their children. The addition of acupressure
beads for both adults and their children shows benefit. One example is the Tree of Life
Chemical Dependency Treatment Program’s Pregnant/Parenting Women’s Recovery Program in
Everett Washington. Anonymous comments from both parents and children are listed below:
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“The pellets have helped tremendously. I have been able to stay focused and my mind
has stopped spinning. My son has been able to stop being so wild. He has calmed down
a hundred percent.”

“I don’t crave or smell or taste my drug of choice. I am focusing on the program more
than ever.”

“I felt calmer at times when I probably would have been more stressed. I thought more
clearly. It was also nice knowing that I had help at hands reach when my anxiety
increases.”

“My 13-year-old son had the pellets about a week ago. He had a pretty intense smoking
habit as well as depression. He has not smoked for a week. His whole attitude has
changed to happiness and well being. He helps people and he’s very thankful for
everything.”

Modified Needle Protocol for Children/Infants: In Oriental Medicine, young people are
considered to have more vibrant energy and require fewer points stimulated for shorter periods of
time.
 Children (small) – use 1 – 2 needle or bead protocol
Shenmen
Kidney
 Babies – use ear seeds or beads, use only one ear, and press on them three to four times
per day.
Shenmen
Kidney
 Premature babies – use ear seeds or beads on only one point on only one ear
Shenmen
or
Kidney

See Appendix “F1” - Lincoln Recovery Maternal Substance Abuse Services

Behavioral Health Issues/Dual Diagnosis

The reality of co-occurring disorders of mental illness and substance abuse, also known as “dual
diagnosis”, and “mentally ill chemical abusers (MICA)”, has gained increasing attention. Some
experts estimate that 60% of the addicted population has a co-existing mental disorder. Co-
existent mental disorders commonly seen include: mood disorders (including bipolar affective
disorder, depression, etc.) anxiety disorders, post traumatic stress disorder (PTSD) and other
trauma-related conditions, dissociative disorders, psychosis and schizophrenia.

Active substance abuse may exacerbate mental illness and may confound underlying psychiatric
issues and interfere with treatment by masking, complicating, or mimicking psychiatric illness.
Mood altering chemicals distort perception/thinking patterns and may affect psychotropic
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effectiveness as well as medication compliance. Therefore MICA individuals need both
addiction treatment intervention and mental health treatment in order to succeed.

Clinical experience has shown the NADA auricular acupuncture protocol to be very effective
for individuals with co-existing mental and addictive disorders. Generally, clients with co-
occurring mental health issues find the treatment decreases anxiety and depression. Programs
document fewer incident reports such as episodes of violence and better compliance with
medication protocols. Programs also report better compliance and fewer adverse reactions
associated with their psychotropic medications.

During the past 35 years at Lincoln Recovery the needling treatment has been observed to offer
numerous effects for patients with co-existing addiction and psychiatric conditions. Agitated
patients routinely fall asleep while receiving acupuncture. Chronic paranoid patients have a
higher than average retention rate. Lincoln Recovery Center recounts many examples in which
grossly paranoid addicted persons have made special efforts to access the protocol without
projecting paranoid ideation on to the treatment, even though they may be floridly psychotic
otherwise. These patients experience a gradual reduction in psychiatric symptoms as well as a
typical response in terms of craving and withdrawal symptoms.

Psychotropic medication does not negatively interact with the NADA protocol. Patients should
remain on psychotropic medicines while using acudetox, since the improved level of
compliance which correlates with acudetox often makes the process of medication more reliable
and effective.

Harbor House, a residential program for mentally ill chemical abusers (MICA) in the Bronx,
reported a 50% reduction in psychiatric hospitalization in the first year of acudetox utilization.
Their drop out rate during the first month of treatment decreased 85% during the same period of
time.

Dually diagnosed patients in an inpatient, state hospital-based program in Pueblo, CO who chose
to receive NADA-style acudetox as part of their treatment were twice as likely to complete the
90 day program successfully as compared to patients who did not use acudetox, as reported in
2006.

The NADA protocol has an obvious advantage in the treatment of MICA clients, because it can
be used for a wide variety of addictive and psychiatric problems. MICA clients have particular
difficulty with bonding and verbal relationships. Acudetox facilitates the required lenient
supportive process, but, at the same time, it provides an acute anti-craving treatment which is
also necessary. The use of acudetox can resolve the contradictory needs of MICA patients.
More work needs to be done to evaluate and understand this anecdotal data.

The Waco, TX Experience:

A pilot program used acupuncture according to the Lincoln model in the public mental health
system in Waco, Texas with a goal of reducing nicotine use. Highly disturbed, non-compliant,
chronic dual diagnosed patients were deliberately selected for this trial. Nicotine use decreased
or ceased and rates of hospitalization dropped from 50% to 6% in the group of 15 patients. The
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patient group was considered to be the most chronically ill and most likely to return to mental
hospitals or jail. They often “self-medicated” through the use of nicotine, alcohol, street drugs
and other substances of abuse in an attempt to relieve the acute symptoms of their disease.
Their need for services ranged from a requirement of 24 hour care to that of intermittent case
management services coordination. Services included social, medical, psychiatric and
psychotherapeutic interventions.

The NADA protocol was introduced to the population because the clients in this case-
management group were spending 60% of the SSI income on cigarettes. The nicotine addiction
caused financial problems, interpersonal difficulties with peers, family and staff, stealing, and
prostituting themselves in order to get cigarettes. Traditional treatment approaches had proven
ineffective.

Case management staff instituted the use of the NADA protocol. Soon after the ear
acupuncture treatments began unanticipated effects were noted by staff, clients and family
members. These included better sleep, reduced stress, a sense of greater relaxation, improved
appetite, increased sense of purpose, clearer mind and more energy. Over time, staff noted that
the number of hospital admissions for the clients decreased dramatically from the average
number of admissions for the previous three years.

Clients of the program were also noted to be more accessible to traditional treatment
methodologies. They were easier to engage interpersonally. Medically related physical
changes were noted, including reduction of high blood pressure and increases in low blood
pressure into normal ranges. The NADA protocol did not reduce the necessity for psychotropic
drugs, the need for case management or psychotherapeutic interventions, but different types of
services had to be developed. More psychosocial activities, including skills development and
the practice of using the new skills became essential in helping patients handle their new found
level of functioning.

Staff was forced to shift their work styles and program offerings to meet client requests. Staff
noticed that their caseload clients were more demanding of services. However, the staff soon
discovered the changes created a more interesting program environment. Clients requested the
formation of a patient government. They wanted more challenging programming. They were
able to welcome newcomers into the environment more easily. They wanted to take field trips.
These requests were quite different to deal with programmatically, than the more medicated and
somnolent atmosphere that had existed before the needling treatment was implemented. There
was clearly more “aliveness” among the clients, and staff soon learned to enjoy the interests and
vitality that clients displayed.

Unfortunately, the NADA protocol was discontinued for this population. Hospital admissions
and violent incident rates which had dropped to zero during the needling implementation,
gradually reverted to original levels.

Acupressure Beads for Attention Deficit/ Attention Deficit Hyperactive Disorder

Attention Deficit Disorder and Attention Deficit/Hyperactive Disorder are both serious
conditions affecting thousands of individuals and families. Modern medicine has little to offer
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except medications with serious side effects. In 1997 Lincoln Recovery began expanding the
clinical horizon to include the treatment of ADD/ADHD on a pilot basis.

Technique: An acupressure bead, easily applied to the surface of the ear by adhesive tape, is
fixed to the posterior surface of the external ear just opposite the location of the “Shenmen”
point on the anterior surface. The location is generally above the superior end of the
“depressive groove”, a physical demarcation on the posterior ear. Often there are observable
indicators of the point location on the surface of the ear. These indicators are typically one or a
combination of the following: distended veins, moderate erythemia, poor skin tone or visible
indentations on the surface of the ear at that location. There is often a clear sensation of Qi
when the bead is applied. The beads are kept in place continuously, and replaced when the
adhesive tape becomes worn. Generally gold beads have found to be most effective, however,
some children respond better to the silver beads. In Oriental medicine, gold is considered to be
strengthening/tonifying and silver is considered to be balancing/calming. Staff in some
programs notice that clients are generally attracted to the metal that provides them the best
benefit. Allowing clients to choose between gold and silver is an easy way to assess which
metal best suits the individual. When in doubt, the energetically neutral vaccaria seeds may be
used.

The technique is easily taught, and even family members can learn to place the bead, for simple
maintenance of the protocol. Medication changes are not suggested without the
recommendation of the primary prescribing physician on the basis of clear changes in the
clinical picture.

The following are anecdotal examples:

1. D.B. was placed on Ritalin 30 mg/day at age 4. He was an angry child, destroying
anything in his way, with an attention span of less than 5 seconds. On daytime
medication D.B. sat unproductively most of the day. In the evenings he was restless,
tearful and hyperactive. By age 14 D.B. was taking Dexedrine, Lithium and Catapres.
His blood pressure was 150/90. He remained somnolent or hyperactive, unable to have
a productive life on any dose of medication. His parents had tried numerous additional
remedies to no avail. At age 14 (in 1996) D.B. responded immediately to his first ear
acupuncture treatment. His sleep and activity patterns normalized within a week. His
blood pressure and symptoms of depression subsided within weeks. Soon D.B. was
using acupressure seeds and beads on a regular basis. His school performance improved
steadily even as the Dexedrine was being discontinued. In 1998 D.B. participated in
drivers education classes, participated in horseback riding, had a part-time job, mentored
kindergarten children, and was able to study for hours at a time. He became a charming,
relaxed young adult, quite aware of his educational deficits and sought to improve
himself on a daily basis. D.B. is able to tell his mother when he needs to have follow-up
acupressure bead treatment.
2. G.H., a five year old boy living in a therapeutic residence because of his mother’s
clinical status. G.H. would stomp his feet frequently and required 7 “time outs” per day
for social management. After one week of acupressure bead placement, G.H. could sit
calmly and no longer required “time outs” for social control. His teacher said that he
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completed his homework and “now he learns so fast.” The beads “make me happy”
G.H. says.
3. D.K. was abandoned at the age of 2 and entered foster care. He was developmentally
delayed and placed on Ritalin and Ativan. At age 12 (1998) D.K. was living with his
aunt and doing poorly even in special education classes. After the acupressure beads
were applied in May of 1998 D.K. was able to focus in school and his bouts of anger
decreased. Soon D.K. began to talk about his mother in a hopeful manner. He visited
her each weekend over the summer and later was able to live with her in a constructive
manner. D.K. no longer takes medication and is able to ask for acupressure beads
whenever he feels it is necessary.

Most of the ADD/ADHD children have responded favorably to this treatment within the
first week of bead placement. Their response seems independent of the family’s motivation
or other psychosocial variations. Treatment effects seem to be unrelated to the use of
medication. These reports are preliminary anecdotal findings. However, it is encouraging
to see apparently unmanageable chronic patients respond favorably to a safe inexpensive
treatment.

Andrea

Andrea is a 14 year old girl who lives in an institution. She has Downs Syndrome,
nystagmus, as well as what the institution staff terms “nervous disorders”, including
attention deficit disorder.

Periodically, the program has the children draw self-portraits. Here is Andrea’s attempt at
drawing herself. Some of the views have multiple eyes, some only one. There seem to be
barbs around her head. In viewing her drawings it would seem that Andrea’s head is not a
very pleasant place to be. Because of her nystagmus, Andrea has difficulty walking down
stairs. She must hold onto the railing and step with one foot, and then the other. Then she
moves her hands down a little farther and begins the process again on the next step. She has
few friends in the program. There is not much in this young girl’s life that looks easy or
comfortable.
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Andrea, before beads

October, 1999
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The inquiry was made of the staff at the institution where she lives; no one knew how long
Andrea had been there, where her parents were or even if she had parents. At some point in
Andrea’s life she was institutionalized, but there is not much information beyond that.

About five months later, the activity of self-portraiture came up again in the children’s routine.
At some point during this time, Andrea had a small gold bead placed on the back of her ear
according to the Attention Deficit protocol developed by the National Acupuncture
Detoxification Association (NADA). The second portrait shows the difference. Nothing else in
the girl’s environment had changed. Clearly, Andrea was in a better space when she drew the
second portrait. Michael O. Smith MD, LAc, developer of the protocol, visited the institution
and observed Andrea before and again several months after the ear bead treatments began. He
observed, not only a change in mannerism, but also Andrea could walk down the stairs much
more easily, one foot per step.

Andrea, after beads

May, 2000
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These drawings speak for themselves. Not every patient will be as severe as Andrea, but the
value of the simple placement of a bead behind the ear is obvious.

Reed Academy in Massachusetts found remarkable benefit in a six week study of using the gold
bead protocol for its students, boys with ADD/ADHD and other severe developmental and
behavioral disorders. Parent, students, nurses and teachers ratings all showed marked
improvement that lasted long after the bead intervention ended. See Appendix “F2” and “F3”.

The NADA Protocol and the Criminal Justice System

Addictions and crime go hand in hand. Historically the addicted population has been a
challenge to the criminal justice system, adding to cost, overcrowding, drug use within the
jails/prisons, and recidivism related to relapse. Likewise the criminal justice mandated clients
have traditionally challenged addictions and behavioral health treatment provision because they
enter treatment begrudgingly, in total denial or with a basic conflict with the referring agency.
Acudetox has become a frequently added element in successful partnerships between the
criminal justice system and addictions and behavioral health treatment providers.

The non-verbal aspect of acudetox allows intake staff to get beyond the court-referred client's
protests and "resistance" and offer acudetox for "stress relief/, instead of forcing the issue.
Acudetox creates space until the clients feel more comfortable and less threatened so they can
admit their addictions and ask for help. Many providers report that acudetox actually helps the
individual to let go of denial and "get honest".

Acudetox and frequent urine testing combine well with criminal justice supervision to provide
the paradoxical "tough love" appropriate for treating the disease of addiction. Acudetox
delivered in a consistent and caring manner provides the basis for the "love" side of the
equation that creates a foundation for the development of more effective discipline.
Frequent urine testing provides an objective non-personalized measure of success that can be
accepted equally by all parties. The counseling process can be totally separated from the process
of judgment and evaluation. Discipline is separated from the difficulties of interpersonal
relationships. Within this context, discipline or leniency by the judicial authority leads to
constructive not escapist behavior. Positive toxicology results are primarily used to require a
more prolonged or intense commitment to treatment.

Drug Courts: “Drug Courts represent the coordinated efforts of the judiciary, prosecution,
defense bar, probation, law enforcement, mental health, social services, and treatment
communities to actively and forcefully intervene and break the cycle of substance abuse,
addiction and crime. As an alternative to less effective interventions, drug courts quickly
identify substance abusing offenders and place them under strict court monitoring and
community supervision, coupled with effective, long-term treatment services.

In this blending of systems, the drug court participant undergoes an intense regimen of substance
abuse and mental health treatment, case management, drug testing, and probation supervision
while reporting to regularly scheduled status hearings before a judge with specialized expertise
in the drug court model. In addition, drug courts may provide job skill training, family/group
counseling, and many other life-skill enhancement services.
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In a February 2005 report, the Government Accountability Office (GAO) concluded that adult
drug court programs substantially reduce crime by lowering re-arrest and conviction rates among
drug court graduates well after program completion, providing overall greater cost/benefits for
drug court participants and graduates than comparison group members (GAO-05-219).”
National Drug Court Institute (ndci.org)

The well-known "Drug Court" program in Miami-Dade County has used the acupuncture-based
model since 1989. This program diverts 2,000 felony drug possession arrestees into treatment
each year. More than 50 % of these clients eventually graduate the program on the basis of
providing 90 consecutive negative toxicologies over the period of a year or more. A video
introduction and full description of all aspects of the drug court program can be viewed at
www.miamidrugcourt.com.

Drug Court developed from the need to find a solution to over-crowded court dockets and a
revolving door phenomenon that was clogging the court system with drug offenders in Miami,
FL. In the late 1980’s Chief Judge Gerald Weatherington took his good friend and colleague,
Judge Herbert Klein off of the bench and sent him out to find a solution. Judge Klein traveled the
country, and finally found a model that he felt would work on a large scale when he visited
Lincoln Recovery in the South Bronx of New York City.

The program elements that Judge Klein found to be significant were the following: the use of
the NADA protocol, as created and implemented at the Lincoln Recovery Center, as a foundation
for drug treatment services, frequent urinalysis testing, an open communication style between the
counselor, the client and any referring state agencies that might be involved, and an
understanding between referral agencies and the treatment program that relapse was a part of
recovery rather than an offense to be dealt with by pulling clients out of treatment and putting
them in jail.

Officials from the Miami-Dade County court system and the Dade County Office of
Rehabilitative Services worked with the Lincoln staff and with NADA Trainer, Janet Konefal
PhD, LAc of the University of Miami to design the court monitored diversion and treatment
program that became the first Drug Court in the world.

Drug courts that have acudetox components have positive reports. A follow-up study in
Santa Barbara, CA, for example, showed that women who received acudetox were 50%
less likely to be rearrested after being released from the county jail. The Broward
County, FL Drug Court program reported a graduation rate of 90% for the group of
clients receiving acupuncture, while the non-acupuncture group had a graduation rate of
56.5 %. An independent program evaluation for the drug court treatment program in
Portland, OR found 76% fewer total subsequent arrests (80% fewer serious felony
arrests) for program graduates than the comparison group. The researchers estimate a
state cost savings of over $10 million for a two-year period.

The Drug Court phenomenon has created new methods and innovations within the
criminal justice and court systems. The basic model has been translated into
Community Courts, Domestic Violence Courts, Mental Health Courts, Juvenile Drug
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Court, Family and Dependency Courts, Sex-Offender Court and other models of
“problem-solving justice”.

Drug Court diversion and treatment programs have been established in nearly 2000 settings
nationwide despite minimal access to outside funding. This expansion represents an increased
commitment to addictions and behavioral health treatment throughout the U.S. Many of the
Drug Court programs use acudetox as a primary component of their protocol. Acudetox is also
being used in jails and prisons in the U.S. and abroad.

Jail-based treatment: In addition to drug court type diversion programs, many correctional
institutions have incorporated acudetox with promising outcomes. While the drug court system
was in development, Dade County officials also had Dr. Konefal implement acudetox to
complement the counseling services provided in the Miami-Dade County Stockade (a minimum
security prison) and the neighboring Turner Guilford Knight Correctional Facility. Acudetox
treatment is offered in jails and prisons through a number of different models in the U.S. and
Europe, examples include pre and post release programs; programs for violent offenders and
women in prison, etc. (The numbers of prisons in Europe using the NADA protocol is higher.)

Sex offenders in a maximum-security prison in Oak Park Heights, MN received acudetox on

a regular basis. There was a significant reduction in anger and violent intrusive sexual
fantasies as compared to a control population (Culliton 1996). Early anecdotal reports for a
San Francisco jail-based program for violent offenders of all sorts reveal dramatic changes
in the environment. Fights on the unit, which used to occur several times per week, desisted
all together.
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Use of NADA in Trauma/Disaster/Crisis

Relief
The Use of NADA in Trauma/Disaster/Crisis
Relief
Neurobiological Effects of Trauma
Treating Trauma/Preventing PTSD
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The Use of NADA in Trauma/Crisis Relief

Modern acupuncturists have a history of responding to natural and man-made trauma and
disaster situations around the globe. It comes as no surprise to NADA practitioners that the
protocol is helpful in these situations. Working in the fields of addictions and behavioral health,
clinicians see clients in crisis frequently. Crises may be related to current situations, or personal
history. Whatever the source, ADSes see time and again that the NADA protocol helps
individuals and groups cope with crises. The nonverbal nature of the treatment makes it an
especially appropriate tool for such situations.
In the 1980’s, Mindy Fullilove, MD documented treatment for women trauma survivors at
Lincoln Recovery. In 1988 an acupuncture team, led by Maria Delores Diaz, OMD, went to
Honduras and Belize following Hurricane Mitch. They trained medical personnel in basic
acupuncture and acudetox techniques, and return periodically to continue training and to support
ongoing availability of acupuncture in the region.
In 2001, NADA India practitioners provided relief to survivors and to social workers and other
relief personnel following the earthquakes in Gujarat, India.

Suneel Vatsayayan, of NADA India, and a colleague placing ear needles.

Following the terrorist attacks in New York City, many city hospitals in the area made their
existing acudetox addiction treatment centers available to trauma survivors. St. Vincent’s
Hospital (located closest to Ground Zero) set up a NADA-based acudetox stress clinic that
offered more than 40,000 treatments to local citizens – well beyond expectations for the typical
crisis outreach program. (St. Vincent’s served affected people who lived and worked in the
neighborhood, their families and the providers who served them, offering the NADA protocol,
reiki and other interventions until the end of 2007.) Other acudetox and acupuncture teams
worked around the clock immediately following the disaster, providing services to the police
officers and fire fighters charged with working “the pile”. CRREW (Community Rebuilding and
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Relief through Education and Wellness) is an acupuncture/massage therapy team that was
created out of the 9/11 disaster, and later went on to work with the NYC Fire Department and the
BEAR Search and Rescue teams.
In 2005, following Hurricane Katrina, NADA practitioners went to Louisiana to provide relief to
the first responders. CRREW, Acupuncturists Without Borders (AWB) and other acupuncture
relief teams served the greater Louisiana and New Orleans population, first with teams sent in to
provide on the spot treatment, and later by training local acupuncturists in the NADA protocol so
that ongoing services could be provided.
Later, in 2005, a NADA practitioner went with Operation Heartbeat to provide relief at the site
of the Himalayan earthquakes in Pakistan. While there he trained members of the Pakistani army
in the NADA protocol.

Marc O’Regan, of Operation

Heartbeat, treats survivors and
trains Pakistani Army officers in
the NADA protocol following the
earthquakes of 2005.

In 2006 the New York City Regional Emergency Medical Response Council invited members of
the crisis relief-experienced CRREW team to join their Critical Incidence Response Team.
In March of the same year the U.S. government began research on the use of full-body
acupuncture to treat PTSD. Walter Reed Army Medical Center offers acudetox to families,
soldiers and first responders.
“Acupuncture, which has few known side effects, holds promise as an effective treatment option
for PTSD. Acupuncture has been shown to improve well-being and has been successfully used
to treat stress, anxiety and pain conditions” (ClinicalTrials.gov DATE??).
Because it is a simple, effective, standardized protocol, the NADA protocol has become the most
accepted and applied acupuncture for disaster/crisis/trauma intervention.
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Neurobiological Effects of Trauma

Trauma can happen to anyone. Not everyone gets PTSD as a result of experiencing trauma. The
development of PTSD can often be prevented if the person is able calm down and sleep after the
trauma and process and digest the experience.

Trauma is a near universal experience for individuals with behavioral health problems. 55% -
99% of women in substance abuse treatment and 85% - 95% of women in the public mental
health system report a history of trauma/abuse. The abuse has most commonly occurred during
childhood and the memories have never been digested and assimilated.

Substance abuse is more often than not a trauma based illness. The traumatized individual often
finds substances as a way to cope with the effects of trauma/abuse. They can “numb” the pain –
both physical and emotional by using substances.

Often people cannot recover from substance abuse unless they process and deal with the trauma
underlying it and relearn to live in a substance free environment and are taught skills to manage
stress/feelings related to the trauma.

The Adverse Childhood Experience (ACE) Study, done by the Centers for Disease Control
(CDC) and Kaiser Permanente interviewed 17,421 adults. The study showed a powerful
relationship between emotional experiences as children and physical and mental health as adults.
Researchers found that time does not “heal all wounds” and people don’t “just get over” some
things – even 50 years later. (Felitti et al. 1998)

The two most important findings were that adverse childhood experiences:
• are vastly more common than recognized or acknowledged and
• have a powerful relation to adult health a half-century later.

The ACE questionnaire contains 10 questions about abuse and household dysfunction. The abuse
categories include: recurrent physical abuse, recurrent emotional abuse, and sexual abuse. The
five categories of household dysfunction include: growing up in a household where someone was
in prison; where the mother was treated violently; with an alcoholic or a drug user; where
someone was chronically depressed, mentally ill, or suicidal; and where at least one biological
parent was lost to the patient during childhood – regardless of the cause. An individual exposed
to none of the categories has an ACE Score of 0; an individual exposed to any four had an ACE
Score of 4, etc.

For example, the ACE study found that a male child with an ACE Score of 6 had a 4,600%
increase in the likelihood of later becoming an intravenous (IV) drug user when compared to a
male child with an ACE Score of 0. Vincent J. Felitti, MD hypothesized:

“Since no one injects heroin to get endocarditis or AIDS, why is it used? Might heroin be
used for the relief of profound anguish dating back to childhood experiences? Might it be
the best coping device that an individual can find? Is intravenous drug use properly
viewed as a personal solution to problems that are well concealed by social niceties and
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taboo? If so, is intravenous drug use a public health problem or a personal solution? Is it
both? How often are public health problems personal solutions? Is drug abuse self-
destructive or is it a desperate attempt at self-healing, albeit while accepting a significant
future risk? This is an important point because primary prevention is far more difficult
than anticipated. Is this because non- recognition of the benefits of health risk behaviors
leads them to be viewed as irrational and as solely having damaging consequences. Does
this leave us speaking in platitudes instead of understanding the causal basis of our
intractable public health problems?” Vincent J. Felitti, MD

From the English translation of: Felitti (2002)

Traumatic experiences result in traumatic memories that are associated with a picture, cognition,
affect and physical sensation. If these are not processed or assimilated – they change little from
the time the event occurred. Although the memories may be of events that occurred long ago, if
they are not adequately assimilated, the client can still respond emotionally and behaviorally in
ways consistent with those traumatic events.

Memory can be thought of as the way we experience something at one time altering the way we
function in the present or the future. Associations are made – “neurons that fire together are
wired together” – and become linked together in a neural net. However, we “remember” only a
fraction of what we actually experience.

We actually have multiple memory systems which include:

1. Perceptual representation system
Visual, auditory, tactile and olfactory inputs are each processed by their respective
regions of the unimodal sensory cortex and then passed on to higher processing regions
(short lived, outside conscious awareness)

2. Episodic memory system

 For long term memories to form the hippocampal complex is required

 Information from both the perceptual and semantic representations flow into the
hippocampal complex
 Memory traces from the perceptual and semantic systems in the cortex are too weak to
support direct recall
 The hippocampus forms a memory of an event that supports its long-term recall
 Details of the memory are not in the hippocampus – instead it stores a set of “pointers” to
the information stored in other systems
 It facilitates the simultaneous reactivation of weak cortical traces in perceptual, semantic
systems as well as amygdala for associated affect
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3. Semantic memory system

Abstracted general knowledge stored in the neocortex

Characteristics of Episodic Semantic

Memory
Content Isolated, distinct Abstracted general
events knowledge

Brain location Hippocampus, medial Neocortex

temporal lobe

Storage density Sparse Dense

Initial strength High Low

Speed of Rapid Slow

consolidation

Longevity Relatively short (but Relatively long (but

can be years) can slowly
disappear with
disuse)

Stickgold R, J Clin Psychology, 2002;58:61-75

Example – Learning Math

 Episodic memories lost – you don’t remember the day, the place, the teacher, etc. when
you learned to do long division, you just remember how to do it
 Semantic memory is not simply a degraded version of original episodic memory – instead
is a separately stored memory that over time has been extracted and abstracted from the
initial episodic memory
 If, for years you use a calculator instead to divide numbers, you tend to forget you can do
this, however, when your calculator is not working, you can make yourself remember
how to do long division, because you have not lost this extracted and abstracted memory.

Sleep plays an important role in memory consolidation

 Non-REM sleep is most critical for strengthening hippocampal memories
 REM sleep is most critical for strengthening neocortical memories
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 Central brainstem neuromodulation of the brain shifts dramatically - domination by

serotonin and norepinephrine during non REM sleep, acetylcholine during REM sleep
 Slow Wave Sleep and accompanying low levels of ACH may mediate a critical memory
consolidation process
Sleep and Memory Consolidation
Power AE, PNAS, 2004;101:1795-1796

Normal Sleep Architecture

 Stage 1 mixed alpha waves/low voltage
 Stage 2 low voltage, sleep spindles
 Stage 3/4 – slow wave sleep (rest for mind) high voltage, slow wave activity
 REM – rapid eye movement – dream sleep (rest for body) low voltage, mixed frequency,
muscle atonia, bursts of rapid eye movement
 Average 4-5 cycles per night
 Full cycle averages 90-100 minutes

Characteristics Waking Non-REM REM

Mental content Logical, progressive Logical, perseverative Illogical, progressive

Brain 5HT, NE Medium to high Medium to low Near zero

Brain ACH Medium to high Low Very high

Communication Bidirectional Hippocampal to Neocortex to

neocortex hippocampal

Function Form episodic Transfer episodic to Integration of

memories semantic semantic memory,
feedback to
hippocampus

Sleep and Memory Consolidation

Power AE, PNAS, 2004;101:1795-1796

The use of addictive substances

 Can significantly diminish/wipe out stage 3 and 4 sleep and diminish REM sleep
 This includes alcohol, benzodiazepines, opioids, marijuana, cocaine, methamphetamines

Trauma causing PTSD

 Consequence of failed memory processing/integration
 Prolonged and inappropriate dominance of specific episodic memories of traumatic
events
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 Brain fails to consolidate and integrate the episodic memory into the semantic memory

Common responses of someone with PTSD

 Avoid stimuli that would reactivate memory
 Using drugs/alcohol to numb the emotional response to the stimuli
 Often no conscious recall of event because surge in cortisol can shut down the
hippocampus, however there is sensory/affective recall

Consequences
 Sleep often fragmented, REM sleep often reduced
 Drugs/alcohol significantly decrease stage 3/4 sleep and diminish REM sleep
 Increased release of E/NE in hyperarousal/hypervigilant states may lead to failure to shut
this down during REM sleep causing processing to shift toward stronger associations
(weak associations normally activated during REM sleep)
 Startle Response
 Biphasic
 Initial cholinergic activation – slows heart – automatic release of attention from
current source
 Fraction of second later, release of adrenaline/NE – increased heart rate – shift
attention to refocus

Which results in:

 Lack of integration of the extracted and abstracted core of episodic memories into
cortical semantic memory networks
 Allowing unimpeded intrusive hippocampal replay of episodic memories

Treating Trauma/Preventing PTSD

Trauma Informed Care

 Realizes the widespread impact of trauma and understands potential paths for recovery;
 Recognizes the signs and symptoms of trauma in clients, families, staff, and others
involved with the system;
 Responds by fully integrating knowledge about trauma into policies, procedures, and
practices; and
 Seeks to actively resist re-traumatization.

SAMHSA’s Six Key Principles of a Trauma-Informed Approach

 Safety
 Trustworthiness and Transparency
 Peer support
 Collaboration and mutuality
 Empowerment, voice and choice
 Cultural, Historical, and Gender Issues
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Four Concrete Steps for Working with Trauma

Bessel van der Kolk, MD and Ruth Buczynski, PhD
 Start with Self-Regulation for people to learn that they can change their arousal system
 Help Your Patients Take Steps Toward Self-Empowerment
 Help Your Patients Learn to Express Their Inner Experience
 Integrate the Senses Through Rhythm

NADA is the first effective tool to help people learn they can self-regulate
 NADA 5-point ear acupuncture protocol
 Safe, effective, low cost, non-verbal treatment that helps patients deal with
anxiety/stress/trauma
 Licensed mental health clinicians can learn to do this and provide treatment depending on
state laws
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NADA is the best tool to use in Disaster Situations for many reasons:

Challenges with Specific Strengths of the NADA

Disaster Aid Problems Model
Projects presented
Cultural competency • Language barriers • NADA is non verbal
• Outsiders doing • Can be performed by local
the work personnel/Easily taught
• Local systems, • Designed to function within
customs aren’t local system
respected
Sustainability • Dependency on • Needles are inexpensive
outside aid • Lay personnel can learn and
• Contracting apply safely and effectively
outside aid • Designed to empower local
specialists is communities
expensive
Appropriate use of • Potential • NADA requires no diagnosis
the Western Psych inappropriateness of • Ear acu is not a drug
Model DSM Diagnosis • Designed to function as a
• Drug therapy and complementary role within the
talk therapy not Western model
always appropriate
Adapted from Ryan Bemis DOM, Ear Acupuncture and Humanitarian Aid, 2013, NADA
literature clearing house

As long as a person can sleep after a trauma, they can process and assimilate the trauma and
“digest” it during sleep, and not develop PTSD. There is evidence that acupuncture can help with
sleep.
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Acupuncture increases melatonin - reduces insomnia and anxiety

 Spence et al. J Neuropsych Clin Neurosciences 2004;16:19-28
 18 adults, continuous insomnia for 2 yrs
 Full body acupuncture 2x week x 5 wks
 Significant increase in nocturnal melatonin (p=0.002)
 Significant improvement in sleep onset latency (p=0.003) and sleep efficiency (p=0.002)
 % stage 3 sleep increased from 4.2 to 6.1%
 Significant reduction in state anxiety (p=0.049) and trait anxiety (p=0.004)

This was with full body acupuncture but most NADA providers report subjective reports of
improved sleep with their clients. This is research that needs to be done with NADA.

It is important to remember that while NADA is the best first step for Trauma/Crisis response,
NADA is not a stand-alone treatment for PTSD.

Accepted Evidence Based Trauma Treatments

 Cognitive Behavioral Therapy CBT
 Trauma Focused CBT
 Cognitive Processing Therapy
 Prolonged Exposure Therapy
 EMDR
 Stands out above the others
 Department of Veteran Affairs – ‘A’ category and strongly recommends it
 APA endorses it as an effective trauma treatment

EMDR – Eye Movement, Desensitization and Reprocessing

 Seems to facilitate the resolution of traumatic memories in a very accelerated fashion
 Thought to facilitate a physiologically based self-healing process
 Requires Master’s level training
 Abreactions can be extreme

EMDR is an alternative way to simulate a REM-like state to facilitate integration of

memories
 EMDR – eye movements in both REM sleep and wakefulness activate similar cortical
areas
 Visual pursuit, bilateral auditory and tactile stimulation require different mechanisms
 All alternating bilateral stimulation forces subject to shift attention across the midline

Similar to REM sleep

 Momentary cholinergic activation
 Brainstem initiates a burst of pontogeniculooccipital (PGO) waves
 Only other condition known to generate PGO waves is REM sleep itself
 Having a subject repetitively reorient attention from one location to another could
produce neuromodulation similar to REM sleep
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Brain Synchronization Therapies

 Softer
 Slower
 Safer
 Can be utilized by anyone who undergoes the training
 Anyone can be trained
 Developed by John Hartung, PsyD, EMDR trainer, Colorado Springs
 Involves using multiple different energy/meridian based therapies to calm down affect
before bilateral movements can be utilized
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Ethical and Legal Issues

ADS Ethics Pledge
Confidentiality/HIPAA
Consent to Treatment
Compliance with all federal, state and local
regulations
Supervision
Please refer to the Acudetox Risk Management (Appendix “C”) for
more details.
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As an Acupuncture Detoxification Specialist, I pledge to:
1. Believe in the dignity and worth of all human beings and to provide service for the welfare and
betterment of all those served by the acudetox treatment, as endorsed by the National
Acupuncture Detoxification Association (NADA);
2. Use acudetox in a supportive and nurturing way in the recognition of the right to humane
treatment of suffering directly or indirectly from alcohol and drug addiction and behavioral health
issues in general;
3. Never withhold treatment as punishment or to use acudetox in a programmatically punitive
manner;
4. Maintain a professional relationship with all persons served and to refer them to the
appropriate service or practitioner promptly when this is not possible;
5. Be committed to a drug-free, sober state for all patients whose primary reason for receiving
acudetox is to support their recovery from addictions;
6. Never to do anything that would weaken the physical or mental resistance of a human being,
except for strictly therapeutic or prophylactic indications imposed in the interest of the patient;
7. Refrain from undertaking any activity where my personal conduct, including the abuse of
alcohol or drugs, is likely to result in inferior professional services, denigrate the profession in
general, or constitute a violation of law;
8. Adhere strictly to the established rules of confidentiality of all records, materials and
knowledge concerning persons served in accordance with all current government regulations
including but not limited to HIPAA;
9. Not associate myself with commerce in such a way as to let it influence, or appear to
influence, my attitude towards the treatment of my patients;
10. Not exploit acudetox for personal gain;
11. Make an effort to keep fees within the reach of the general public and to offer sliding fee
scales for those patients who require such consideration;
12. At all times to maintain the highest standards in all the services I provide, valuing
competency and integrity over expediency or temporary success:
13. Support NADA’s mission and the organization, including the Registered Trainer-based
training system and, when possible, give back and maintain an active membership;
14. Provide accurate information regarding my education, training, experience, professional
affiliations, certifications and licensure;
15. Not claim directly or by implication professional qualifications exceeding those that I have
actually attained;
16. Recognize the limits of my ability, providing services only in those areas where my training
and experience meet recognized professional standards;
17. Accept the fact that training in the acudetox technique does not imply competency to use
acupuncture in general unless so trained and licensed;
18. Limit my practice of acupuncture to the NADA protocol unless I am a permitted to perform
acupuncture in general under the scope of practice of my professional licensure;
19. Regularly evaluate my own professional strengths and limitations, biases and levels of
effectiveness and to strive for self-improvement by seeking professional development through
further education and training. When appropriate, I agree to have my technical competencies
reviewed by a NADA designated consultant and/or Registered Trainer;
20. Practice acudetox in accordance with state, provincial and/or local regulations where such
exist;
National Acupuncture Detoxification Association
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21. Seek supervision as needed and as required by state, provincial and/or local regulations;
22. Respect the integrity of other forms of health care and to make efforts to build bridges and
develop collaborative relationships to achieve the best possible care for individual patients;
23. Use acudetox in conjunction with appropriate counseling and supportive services;
24. To contribute my ideas and finding to the general body of knowledge concerning acudetox
and acupuncture for behavioral health issues;
25. Make public statements regarding the effectiveness of acudetox that are within the generally
accepted experience of the profession as a whole or within the individual practitioner’s
experience;
26. Use great caution in publishing discoveries and methods of treatment whose value is not yet
recognized by the profession at large; and
27. Always recognize that I have assumed a serious social and professional responsibility due
to the intimate nature of my work that significantly touches upon the lives of other human
beings.
National Acupuncture Detoxification Association
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National Acupuncture Detoxification Association
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Client confidentiality
The implementation of the Health Insurance Portability and Accountability Act of 1996 (HIPPA)
is provided for in The Standards for Privacy of Individually Identifiable Health Information
(Privacy Rule). The types of programs (“covered entities”) addressed in the Privacy Rule are,
“any health care provider who transmits health information in electronic form in connection with
transactions for which the Secretary of HHS has adopted standards under HIPAA” (Office for
Civil Rights, 2003). The type of “individually identifiable health information” protected under
the Rule (“protected health information”) includes any information that identifies or can be used
to identify the individual and relates to the person’s past, present or future mental or physical
condition or health and to the provision of or payment for treatment to the individual. Even for
programs that do not transmit data electronically, HIPPA and the Privacy Rule have become the
de facto standards for assuring confidentiality of patient records. (See Appendix "G 3")
There are additional Federal Laws and Regulations that address the confidentiality of addictions
treatment records including 42 USC 290dd-3, 42 CFR Part 2 and 42 USC 290ee-4. These
statutes prevent programs from confirming a person is a client of a program or any other
identifying information, unless the client gives written permission, the program is ordered by a
court, or in the case of a medical emergency.
Informed Consent
Because acudetox is considered an invasive procedure (i.e. the needles break the skin barrier),
clients must sign an explicit, written informed consent prior to receiving acupuncture. This
informed consent must be made part of the clients’ record and may be rescinded at any time.
Failure to obtain informed consent prior to providing acudetox treatment can be legally
prosecuted as a form of battery (Wagner RA, 2006). Client must voluntarily give consent
without duress or coercion.

For a client to provide explicit informed consent he or she must exhibit the competency to do so.
Legally this means the client must be able to understand all of the options, the consequences of
accepting each option and the personal cost and benefit of accepting or declining each option.
The acudetox program must describe the treatment including the expected benefits and risks and
the client must be able to comprehend the information.

In many acudetox programs, treatment is delivered not only by acupuncturists and ADSes, but
also by individuals in training. In these situations, the Informed Consent needs to clearly state
that the treatment may be provided by trainees/students, in addition to licensed acupuncturists or
ADSes.

Compliance with State Laws, Rules and Regulations

States vary dramatically regarding their laws and allowable practices for acudetox. Ethical
acudetox practice then requires adherence to those laws whether or not they are more restrictive
than other states. Always check State Law prior to initiating an acudetox program, including the
possible need for medical history, physical examination and/or physician referral prior to
needling.
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Supervision
Most states that allow non-acupuncturist ADSes require supervision of the acudetox treatment by
either licensed acupuncturists or other healthcare providers whose scope of practice allows them
to practice acupuncture without supervision such as physicians.

In several states the statutes place the burden of assuring that paperwork is maintained according
to established standards on the supervisor. Even in states where this requirement is not
specifically stated, the supervisor may very well be considered the “expert” and it is his or her
responsibility to assure that proper risk management measures are in place. Even if not required
by state statute, have written agreements in place between the program and the supervisor and
between the supervisor and ADSes and ADS trainees outlining the responsibilities and duties for
which each party is responsible.

In states where supervision is not required or where the ADSes are required to be acupuncturists
or other healthcare providers whose scope of practice allows them to practice acupuncture
without supervision, the impetus to assure safe and ethical use of acudetox falls on the
ADS/healthcare provider themselves as well as the programs in which the procedure is being
performed.
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National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Section X: Addiction & Recovery 123

The Nature of Addiction and Recovery

Models for understanding addictions and
behavioral health and recovery
Treatment models (see Applications and
Outcomes - Section V)
Pharmacology of psychoactive substances

Attendance at mutual support fellowships (see Section V)

(NADA generally recommends attending at least two such
meetings as part of the ADS training.)

See Appendix “H 5” and www.nida.gov for more information.

National Acupuncture Detoxification Association
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National Acupuncture Detoxification Association
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Models of Addiction and Behavioral Health and the Treatment Thereof

There are many ways of understanding addiction. They vary with culture and current research
trends. Addiction was considered through some stages of history to be a form of demonic
possession or a lack of character. Since the middle of last century, medical and psychological
theories and practices have adhered to more medically oriented models, such as what is often
coined, “the disease model”, which considers addiction a chronic, progressive, relapsing,
treatable disease often compared to others such as diabetes. The advantage of this model lies
chiefly in reducing the stigma and focusing on treatment and recovery or “remission”. Current
trends in medicine and research afford a vast understanding of the mechanisms of the brain
involved in addiction.

All models are helpful and limited. NADA does not take a position on what is the “right” model
for understanding addiction.

Addiction treatment also follows cultural, historical and funding-driven trends. In the United
States, federal and state funded as well as privately funded treatment programs are often
overseen by state agencies. NADA does not take a position on what it the “right” model of
treatment, other than to encourage client-centered treatment, consistent with NADA’s model of
barrier-free access to a supportive environment which repects the dignity of the individual and
the importance of the personal internal foundation necessary to sustaining recovery. Addiction
treatment also follows cultural, historical and funding-driven trends. In the United States, federal
and state funded as well as privately funded treatment programs are often overseen by state
agencies. NADA does not take a position on what it the “right” model of treatment, other than to
encourage client-centered treatment, consistent with NADA’s model of barrier-free access to a
supportive environment which respects the dignity of the individual and the importance of the
personal internal foundation necessary to sustaining recovery. Using the vocabulary of Oriental
Medicine, on which the protocol is based, the NADA treatment model accomplishes this by
providing an atmosphere that is yin in its nature, which calms the empty fire exemplified by the
addictive process.

NADA does encourage involvement with mutual support fellowships and encourages ADSes to
be familiar with 12 step and other such groups in their communities as these provide the ongoing
support to recovery-living beyond treatment programs (See Section V, and Appendix “H 3”).

NADA does not presume to provide a comprehensive training in addictions and behavioral
health or their treatment.

The National Institute of Drug Abuse, nida.gov is a good resource for those seeking further
information on addiction and substances of abuse. Almost every community has good training
programs available.

See “H 5” for more information.

National Acupuncture Detoxification Association
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Addiction and Recovery.
Michael O. Smith, MD, DAc

A. The nature of drug abuse

1. It all starts with the adolescent inside of us
a. Need for privacy, identity, and self-esteem
b. There are mood swings, over-reactions, and a loss of focus
c. Some have never had a stable comfortable identity
d. Others have been robbed of their self-esteem by trauma, job loss, personal
crisis, etc.
e. Isolation, shame and “encapsulation” ensue
f. The person is fearful and wants to avoid their own consciousness
g. The person abandons any faith that interpersonal communication can help
resolve problems
h. The person becomes self-centered and unresponsive because of failure and
desperation, not out of hedonistic choice
i. The person often talks about seeking pleasure and avoiding pain because this
simplistic frame of references avoids any risk of painful disappointment
j. The person often chooses negative and degrading relationships which match
and reinforce shame when failure occurs

2. All these developments usually occur before regular drug use has begun
a. Drugs offer peace at any price
b. They provide a reliable escape from personal consciousness and the risk of
unpredictable pain
c. Addiction is the disease of “more”

3. When abusive chemicals take control of a person’s life, these changes become
overwhelming and seemingly irreversible.
a. Mere availability of drugs during adolescence and during adult personal crisis
is dangerous
b. Co-dependency involves the family and adjacent society in the addiction

B. The nature of drug abuse treatment and the recovery process.

1. Adolescence is a natural process. It is the transitional passage form the dependency of
childhood to the autonomy of adulthood. Even though noise and sexuality are
displayed on the surface, adolescence is primarily a spiritual quest for inner self-
development. It is driven by a biological clock and hence it is intrusive and painful.
Nevertheless most of our adult personality was first developed and tested during
adolescence.

2. Drug treatment and recovery is essentially an effort to resolve an adolescent crisis.

a. Initially treatment involves the management of chemical symptoms of
withdrawal and craving.
b. It involves safety, social support and education about addiction and basic
issues of interpersonal growth
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c. But, most of all, recovery means “self-help”, a rather lonely path through and
adolescent terrain.
d. Support groups and counselors can be helpful. They teach a person to “let go”
of issues that can’t be changes and to focus efforts “one day at a time.”
e. Even so, re-defining and re-discovering our self can only be done by
ourselves.
f. It is what we call an “inside job”.
g. For many or us, adolescence is a fearful, alienating word.
h. Look around you, everywhere you see people who have met the challenge of
adolescence—both as teenagers and later because of trauma, personal crisis or
addiction.
i. As they say, “treatment works”, recovery is a realistic goal.

3. The saying “tough love” is the best description of treatment strategy.

a. It represents a seemingly impossible combination of strong discipline and
unquestioning support.
b. Yet “tough love” is a part of any parenting or teaching effort. There is a never-
ending challenge to discipline and to love appropriately.
c. Tough love applies to the old addicted self, but also it applies to the newly
developing self. We must apply tough love to ourselves and our loved ones.
d. Terms like “family values” and “just say no” trivialize this experience

3. Persons facing an adolescent crisis are delicate but they also seek out discipline.
a. Those who are easily hurt often are found with sadistic companions.
b. Addicted persons do not respect “enablers”. They may beg and manipulate;
there is no possibility of appreciation or respect.
c. It is almost impossible to give an addict anything, because everything will be
bartered for more self-destruction.
d. Both discipline and self-appreciation have to be re-discovered and relearned.

4. Unique difficulties which separate drug abuse treatment from other forms of health
care.
a. Denial and resistance. On the day we write everything down, the patient is
least likely to tell the truth.
b. We can’t prepare a person for a relapse and retain them in treatment.
c. “My counselor said” is one of the most dangerous sentences.
d. There is an immediate loss of comfort and love objects when a person enters
treatment.
e. It is very difficult to be soothing and supportive without enabling the
addiction.
f. A person must admit weakness to be helped.
g. Our patients remain on the wrong side of the Serenity Prayer, that is they
accepted their own failure as unchanged.
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Pharmacology of Psychoactive Substances
Rachel Diaz, LAc
VARIABLES DETERMINING DRUG EFFECT

DOSE
Illegal drugs have widely variable and unpredictable drug concentrations.
TOLERANT DOSE LEVEL is an important factor in addicted individuals.
LIPID (FAT) SOLUBILITY determines duration of drug effect.

ROUTE OF INGESTION
Inhalation Intramuscular
Intravenous Mucosal
Swallowing

SET AND SETTING

Set = Internal conditions of user at time of use (mood, expectation)
Setting = External conditions of user at time of use (environmental factors)

Other Drugs in Combination

Potentiation
Antagonism
Adverse side effect modulation

Biochemical Individuality
Acute sensitivity
Addiction Potential

ALCOHOL

ACUTE USE SYMPTOMS CHRONIC USE SYMPTOMS

Sedation – drowsiness to comatose Tolerance
Relief of anxiety Liver and Brain damage
Disinhibition Neurological damage
Impairment of motor coordination Impotence in Males
Blackout (very rapid consumption) Malnutrition
Memory problems
Mood swings
WITHDRAWAL EFFECTS Pancreatitis
Anxiety Ulcers and other gastric problems
Tremors Fetal abnormalities/Birth defects – FAS
Heart rhythm irregularities
Hallucinations – visual, auditory, tactile
Convulsions
Coma
Death
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COCAINE/CRACK
AMPHETAMINE/METHAMPHETAMINE (CRYSTAL, ICE)

ACUTE USE SYMPTOMS

PHYSICAL: EMOTIONAL/BEHAVIORAL:
Increased heart rate and blood pressure Euphoria and hyper stimulation
Dilated pupils Decreased appetite
Seizures Increased wakefulness
Delayed ejaculation/prolonged orgasm Enhanced feelings of power/control
Local anesthesia (cocaine)

CHRONIC USE SYMPTOMS WITHDRAWAL SYMPTOMS

Tolerance ACUTE
Jitteriness/anxiety Agitated depression
Weight loss Extreme drug craving
Other drug use
Skin picking/ulcerations PROLONGED
Problems with memory and concentration Aphoria
Extreme drug craving Episodic drug craving
Financial problems
Fetal damage and death
Binging
Mood swings
Insomnia
Paranoia

HEROIN AND OTHER OPIATES

ACUTE USE SYMPTOMS CHRONIC USE SYMPTOMS

Decreased heart rate, blood pressure Constipation
& respiration rate Decreased sexual interest
Constricted pupils Tolerance
Drooping eyelids and slurred speech
Sleepiness/sedation
Nausea
Relief of physical/emotional pain (analgesia)

HEROIN
Criminal lifestyle to support habit
Lifestyle changes
Hepatitis and HIV infection through needle sharing and other HIV high risk acts

WITHDRAWAL EFFECTS
Flu-like symptoms
Runny nose, watery eyes, dilated pupils, “goose flesh”, stomach cramps/diarrhea,
increased heart rate/blood pressure, intense discomfort, fear of pain (specific to opiate addicts)
National Acupuncture Detoxification Association
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NICOTINE WITHDRAWAL SYMPTOMS

INITIAL ACUTE PHASE

2 – 7 DAYS AFTER CESSATION
Flu-like symptoms
Headache
Digestive and bowel disturbances
Sleep disturbances
Anxiety
Craving
Mild cognitive impairments – memory, concentration and attention problems, easy distractibility
Depression

PROLONGED PHASE
1 – 8 WEEKS AFTER CESSATION
Episodic cravings – generally in response to conditioned cues
Episodic irritability and short temper
Weight gain in response to overeating

MARIJUANA
ACUTE USE SYMPTOMS
“Red eyes”
Slight impairment of short term memory
Impairment of psychomotor skills
Problems with concentration/attentiveness
Disinhibition
Panic attacks

CHRONIC USE SYMPTOMS

PHYSICAL
Bronchitis
Decreased vital lung capacity
Tolerance

PSYCHOLOGICAL
Impaired learning
Impaired motivation
Impaired concentration and mental acuity

WITHDRAWAL EFFECTS
Irritability
Drug craving
Changes in appetite
Sleep problems
Vivid dreams
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FORMS OF WITHDRAWAL OR SYMPTOMS

REQUIRING REFERRAL

1. ALCOHOL WITHDRAWAL
Moderate to serious alcohol withdrawal with poor relief from acupuncture.
 History of seizures, hallucinations, severe tremors, or hypertension with withdrawal
 Long history of drinking with a recent long and/or heavy binge and an abrupt
discontinuation.
 Blood pressure greater than 140/90; pulse rate greater than 100 bpm.
 Moderate to extreme tremor, flushing.
 Anxiety, sleeplessness, withdrawal lasting more than 24—36 hours.
 Convulsions, coma

2. HEROIN WITHDRAWAL
 Diarrhea and vomiting over 24 hours and/or not controlled with acupuncture.
 Increased symptoms with muscle cramping, gooseflesh, “crawling skin”, more than
24 hours and not managed with acupuncture.
 Client’s experience continuous cravings and still live where the drug is easily
available.

3. COCAINE, CRACK, METHAMPHETAMINE WITHDRAWAL

 Profound depression (antidepressants may take 2 – 3 weeks to work).
 Detox is relatively easy – relapse prevention is the major issue; triggers and
conditioned response
 Behavioral interventions are needed
 Clients experience continuous craving and still live where the drug is available
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Substance Abuse Disorders
Diagnostic and Statistical Manual 4th Edition (DSM-IV)
of the American Psychiatric Association

Criteria for Substance Dependence

A maladaptive pattern of substance use, leading to clinically significant impairment or distress,
as manifested by three (or more) of the following, occurring at any time in the same 12-month
period:
1. tolerance, as defined by either of the following:
o a need for markedly increased amounts of substance to achieve intoxication or
desired effect
o markedly diminished effect with continued use of the same amount of substance
2. withdrawal, as manifested by either of the following:
o the characteristic withdrawal syndrome for the substance
o the same (or a closely related substance is taken to relieve or avoid withdrawal
symptoms
3. the substance is often taken in larger amounts or over a longer period than was intended
4. there is a persistent desire or unsuccessful efforts to cut down or control substance use
5. a great deal of time is spent in activities necessary to obtain the substance (e.g. visiting
multiple doctors or driving long distances), use the substance (e.g. chain smoking), or
recover from its effects
6. important social, occupational, or recreational activities are given up or reduced because of
substance use
7. the substance use is continued despite knowledge of having a persistent or recurrent physical
or psychological problem that is likely to have been caused or exacerbated by the substance
(e.g. current cocaine use despite recognition of cocaine-induced depression, or continued
drinking despite recognition that an ulcer was made worse by alcohol consumption)

Specify if:
With Physiological Dependence: evidence of tolerance or withdrawal (i.e. either Item 1 or 2 is
present)
With Psychological Dependence: no evidence of tolerance or withdrawal (i.e. neither Item 1 or
2 is present)
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Criteria for Substance Abuse
 A maladaptive pattern of substance use leading to clinically significant impairment or
distress, as manifested by one (or more) of the following occurring within a 12 month period:
1. recurrent substance use resulting in a failure to fulfill major role obligations at
work, school, or home (e.g. repeated absences or poor work performance
related to substance use; substance-related absences, suspensions or
expulsions from school; neglect of children or household)
2. recurrent substance use in situations in which it is physically hazardous (e.g.
driving an automobile or operating a machine when impaired by substance
use)
3. recurrent substance-related legal problems (e.g. arrests for substance related
disorderly conduct)
4. continued substance use despite having persistent or recurrent social or
interpersonal problems caused or exacerbated by the effects of the substance
(e.g. arguments with spouse about consequences of intoxication, physical
fights)
 The symptoms have never met the criteria for substance dependency for this class of
substance

Criteria for Substance Intoxication

 The development of a reversible substance-specific syndrome due to recent ingestion of (or
exposure to) a substance. Note: Different substances may produce similar or identical
syndromes.
 Clinically significant maladaptive behavioral or psychological changes that are due to the
effect of the substance on the central nervous system (e.g. belligerence, mood lability,
cognitive impairment, impaired judgment, impaired social or occupational functioning) and
develop during or shortly after use of the substance.
 The symptoms are not due to a general medical condition and are not better accounted for by
another mental disorder

Criteria for Substance Withdrawal

 The development of substance specific syndrome due to the cessation of (or reduction in)
substance use that has been heavy or prolonged.
 The substance-specific syndrome caused clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
 The symptoms are not due to a general medical condition and are not better accounted for by
another mental disorder.
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Appendices
A. The Lincoln Story 136

B. Sample Client Information and Forms 140

C. Acudetox Risk Management 144

D. Research 156

E. Excerpts from
Treatment Improvement Protocol (TIP) 45 168

F. Special Populations 171

G. Sample Program Forms 186

H. Selected Monographs on Addiction and Recovery 190

I. Supplies, Vendors, Publications 209

J. Acudetox References 215

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National Acupuncture Detoxification Association
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Appendix A
The Lincoln Story

with excerpts from Fighting Drug Abuse with Acupuncture

by Ellinor R. Mitchell

NADA, the organization, and the NADA 5-point protocol directly attribute one place and time as their
origin. The birthplace of acudetox was originally known as the Acupuncture Clinic, Substance Abuse
Division of the Department of Psychiatry of Lincoln Hospital; later known as Lincoln Detox; and
currently known as Lincoln Recovery.

Lincoln Recovery was established in 1970 in response to community needs, and was created via
community activism. Initially, methadone was used to detox clients from heroin. By 1974
acupuncture had been introduced and became an integral service in the clinic. The program was
created in the community-based self-help model, as a result of a community activist response to the
growing drug problem and lack of services available. A small contingent of professional medical staff
was supplemented by many neighborhood volunteers in a collective and non-hierarchical model.

The circumstances which necessitated the program also shaped its design and growth. Those same
grassroots strategies pervaded the spread of the acudetox culture with the development of the
organization, NADA, and the proliferation of NADA-styled treatment programs across the country
and around the world.

To understand the birth of Lincoln Recovery and the development of acupuncture in its use, it is
important to review the times in which it came into being. In 1970 New York City, an addicted person
could wait a year to receive a slot in a treatment program. Those familiar with addiction understand
that many negative things can happen to an individual, their family members and to the societal
context where they live, use and support their habits. It was not uncommon for an addicted person to
die from drug-related causes before their opportunity for treatment arose.

Also in 1970, a common strategy for dealing with the lack of responsiveness of municipal government
was the practice of civil demonstrations. The often powerless in our society took to sit-ins and other
disruptive demonstrations to force action from the leaders. In November of that year a confluence of
activist groups created the United Bronx Drug Fighters, and demanded the creation of a drug-
detoxification center at the local Bronx public hospital. At the time, Lincoln Hospital had no drug
treatment program.

Community activists had a large hand in making the program happen, and therefore felt they had a
stake in administering the program. Within the cultural context there was a demand for neighborhoods
to develop their own programs and treat their own ills. The Young Lords, a radical Puerto Rican
group and the Black Panthers, a militant black group were both part of the community forces that
came together to provide social services to their communities. These programs included not only
addictions treatment, but also generalized health clinics, breakfast programs for disadvantaged
children and other social services. The influence of these counter-culture groups was definitely felt
within the structure and function of Lincoln Recovery. The groups provided political education
classes and instructions on how to navigate the often red-tape ridden social services provided by local
government, as well as security for the addiction treatment clinic.
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Lincoln Recovery was initially an outpatient detoxification program, using methadone. It was the first
of its kind. Prior to this, there were outpatient methadone maintenance programs, but none were detox
programs. The idea was generated from the experience of one man, Butch Ford, who had been
detoxing people with methadone in the basement of his Bronx home. Based on Butch’s experience
and his success in detoxing a number of people in the neighborhood, it was decided that when the
community came together to create a program that it would follow his methods.

According to NADA founder and long-time director of the Lincoln Recovery Program, Michael O.
Smith MD, DAc, “we had gotten a lot of doctors at Lincoln to be willing to double up in their dorm
rooms so that we could really run a detox unit at Lincoln…

“When the day came, at noon we just walked in and took the elevator and went up to the sixth floor…
Later in the day there was a symbolic arrest of a few people in the program. That lasted a few hours.

“Over that weekend there was a discussion with then chairman of psychiatry, Gabe Koz, and some of
us who were involved. And they said, ‘Well, Monday morning we’re going to do an outpatient
methadone detox program.’

“There were about 200 people waiting in line the next day…..we asked people waiting in line if they
could help read and write, and do some of the paperwork.”

The current staff design was born out of that need, from day one, of a support staff system that
combined the knowledge and experience of former clients to augment the small clinical staff.

“We had a huge volunteer group,” Smith said, “and we started in the auditorium of Lincoln Hospital.
We were an innovative program from the beginning. We were the only outpatient detox program.
And we immediately served a lot of patients in the hospital. Nursing people, a lot of people were very
sympathetic, because this was a service-oriented thing.”

The addition of acupuncture to program services began sometime in either late 1973 or early 1974.
Many of the staff had concerns about the use of addictive drugs to treat substance abuse. When Dr.
Wen, in Hong Kong, published results of success with heroin addicts using acupuncture, the staff at
Lincoln became interested in the method.

Not only the staff, but also the clients were interested in natural methods, and demanding non-
pharmaceutical resources. A long-time staffer at the program noted, “It was the clients that wanted
something else besides methadone. We had old methadone users—I’m talking 30, 35, 40 years, which
is old in addiction – and they wanted another method of detox, because they didn’t like the methadone.
They were really dead set on us finding another method for them to detox and stay clean. That’s how
we really got into acupuncture.”

The staff sought acupuncturists who would come to Lincoln and demonstrate. Many donated their
time to the pioneer program. They started with the protocol used at Kwong Wah Hospital, which was
to needle the Lung point on the ear and add electrical stimulation. The effect lasted for about 6 hours.
Eventually the electrical-stimulator broke. The staff discovered, much to their surprise, that the non-
electro potentiated treatment had a more prolonged effect.
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This development had a major effect on the proliferation of the acupuncture treatment. Using plain
needling (without stimulation) was a more flexible and less expensive process. It was easier to learn
and more easily replicated as the protocol was modeled in other treatment programs. The eastern
philosophy of less is more was proven to be true.

Once the effectiveness of the acupuncture was established, many of the Lincoln staff, including Dr.
Smith, went on to study acupuncture. Over time, and with much experimentation of various ear and
body points, the current 5-point NADA protocol was developed.

The early emphasis on grassroots involvement that created Lincoln Recovery has always flavored the
means with which the NADA protocol has spread. Many of the initial program founders and workers
have passed, or their radical and anti-establishment methods caught up with them. Among those
important program generators are Jose Aponte, Matulu Shakur, and Richard Taft MD.

The story of Dr. Richard Taft’s death, probable murder, soon after the launch of Lincoln’s acupuncture
program is one illustration of the tenacity of the program.

Dr. Taft was found dead in the storage closet of the auditorium at Lincoln Recovery, where much of
the program activity took place. There was an apparent attempt to make his death look like a drug
overdose, potentially harming the program’s reputation. However, those familiar with drug effects
could easily tell that this was not the case.

He was found lying on his side, in an unnatural position, as though his body had been fit into a small
space after death. His long sleeve shirt and jean jacket were buttoned at the cuff (which could not
have happened in the event of a heroin overdose). There was drug paraphernalia near him, but no
matches, no cooker or keys to the room (which was always kept locked) and both doors were ajar. His
wallet and money were found on his body. The coroners report found no needle marks and no heroin
in his urine. However heroin was found in his tissues. His body had a large bruise and indentations in
the back of the head, as well as scratches on his wrists. He was not addicted to heroin, nor was he
suicidal. A fresh needle mark should have been very easily found.

Two months prior to his death, Dr. Taft had received death threats, had begun carrying a weapon for
protection, and he had noted to colleagues that he was in fear for his life. On the day of his death he
was scheduled to meet a high ranking Washington official regarding funding for the Lincoln Detox
Acupuncture Program. The Washington officials did arrive at Lincoln later that same day. However,
the moment they entered Lincoln Recovery a bomb threat was telephoned in to the hospital. The
hospital newsletter carried an accounting of the entire questionable incident along with the following
eulogy:
“In Memory of Richard Taft

“Richard Taft, a man, a doctor and above all, a revolutionary. As a man he supported the right
and fought the wrong.
“For over four years he served in the South Bronx community. He served for one year as
medical doctor in the People’s Program, Lincoln Detox. He was instrumental in training paramedics
and researching acupuncture as the non-chemical treatment from narcotic withdrawal. It is perhaps
this involvement that led to his death.
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“He dedicated his life to help people fight their addiction problems with his medical and
acupuncture knowledge. It was this dedication that made him continue his work even under the threat
of death, even after being shot at. STOP THE DRUG PLAGUE!”

Dr. Smith noted that after Richard’s death many at Lincoln thought the program would be shut down.
That reality failed to materialize. This left Smith, who had been providing medical services in the
basement floor of the building, to take on the role of director of the program.

Characteristic of the service orientation of the program, even as Dr. Taft’s body was found and police
arrived to investigate, the auditorium filled with clients and treatment continued without missing a
step.

However controversy continued to follow the program. In the late 1970’s it became a target, as did
many social programs, of political attack. The fact that security for the treatment center was run by
radical ethnic groups was used against the program. On the Monday after Thanksgiving in 1978 the
hospital chained the doors to the program and did not let anyone associated with the program,
including staff, enter the building. The programs records and equipment were inaccessible. The staff
thought that the end had finally come.

However, there was another location nearby, a former Public Health Station, which was sometimes
used for program services. Staff picked up and moved down the street and around the corner to the
current location for Lincoln Recovery. It was expected that they would be followed and shut down
again, but that never happened.

One staff member noted, “We couldn’t bring methadone over here because this building is not good on
security. We had to quit giving out methadone. Then we had to really get into acupuncture full-time.
We were getting away from methadone, anyway, because it was a drug, and we were against drugs.”

The relocation of the program was not an easy transition. The place was a “dump”. At times they
worked with umbrellas over their heads. There was no heat in the building. The staff performed
housekeeping services because the hospital did not provide them. They also did outreach to the
community by providing mobile units that would set up in specified areas within the neighborhood to
provide additional services.

Anyone visiting Lincoln Recovery today may notice the modest surroundings and an environment that
continues to speak to the community’s ownership of the program. For an addict this is important. The
treatment center must be the place that they are most comfortable returning to, even when they feel
their worst. Clients are naturally encouraged to seek treatment in times of trouble because the
treatment center fits who they are and reflects the local culture.

The grassroots efforts by the founders of the People’s Program at Lincoln and their desire to create a
program that was built for the community by the community has withstood the test of time and
proliferated across the globe. The intention to provide accessible methods of serving an urban
community developed into a model of treatment that fits current customs, but harkens back to the
“barefoot doctor” tradition of acupuncture as healthcare for the masses in rural China. The cultural
consequence of 20th century radicalism resulted in NADA’s emphasis on barrier-free, drug-free access
to care.
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Appendix B:
Client Information
B 1 - Acudetox Client Instructions
This program offers acudetox to assist your recovery process. Here are a few suggestions for you to follow:
Try to eat before you have a treatment. When possible try not to have coffee, cigarettes, or heavy meals for
about one hour before and after treatment (but don’t skip acudetox if you do).
It is a good idea to use the restroom before treatment.
Remind the Acupuncture Detoxification Specialist (ADS) each day if you are a hemophiliac/”bleeder”.
Have your ears accessible, but you do not need to remove earrings or hats. If you have long hair, braids or
dreadlocks, it is a good idea to tie your hair back so the needles don’t get knocked out.
Prepare your ears with an alcohol soaked cotton ball or wipe, take a seat and relax. If you are taking antabuse
or Flagyl, use soap and water or other non-alcohol based cleanser to clean your ears.
Acudetox is nearly painless, but some people experience a brief pinch when the needles go in. The ADS can
show you how to take relaxing breathes to minimize discomfort. Once the needles are placed the sharp
sensation goes away.
If you experience any discomfort during the treatment, notify the ADS who can adjust the needles slightly.
Some people feel sensations such as warmth, tingling, itching or electrical sensation from the needles. These
are normal.
It is better to sit with your feet flat on the floor and your arms uncrossed.
Treatment time will be relaxing and stress releasing. You may fall asleep.
We encourage silence or quiet conversation. Please respect yourself and other clients by keeping the noise level
down.
If one of your needles falls out and is easily visible and accessible you may retrieve it and notify the ADS. Do
NOT touch any needle that is not yours!
Sit quietly with the needles for forty-five minutes. Remove your needles when you are done or notify the ADS,
according to program rules.
Occasionally, a point will bleed when the needle is removed. This is normal also. Press a dry cotton ball or Q-
tip to the site for thirty seconds.
Dispose of all needles and blood contaminated cotton balls in the red/biohazard containers. We need your help
to make sure no needles are lost. Please keep count of the number of needles you put into the container and
search carefully for any that may have fallen to the ground. Please do NOT put needles into the trash container.
You may feel sleepy after the first few treatments. With regular acudetox you may sleep better, feel more
rested, have more energy, and think more clearly. Some people don’t notice any particular change related to the
acudetox except that they are not using drugs/alcohol or engaging in compulsive behaviors.
Treatment may also stimulate the release of emotions for some people. It is important to acknowledge these
feelings as part of the healing and recovery process.
Remember, recovery from any substance or behavioral compulsion is an ongoing process. Acudetox supports
the process at every stage. It helps establish balance in life.
If available, enjoy a cup of Sleepmix/herbal tea following your treatment. It is not a narcotic or sedative, but
will help you relax and sleep better at night. It is safe and non-addictive and a good alternative to the over
stimulation of coffee or soft drinks. It helps to drink a cup at bedtime too. Acudetox treatments have a
cumulative effect. Come back as often and as substance free as you can.
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B 2 - Client Evaluation
ACUDETOX CLIENT TREATMENT EVALUATION
Please read the statements below. Place a check mark in the space before any statements
which apply to you. Mark as many as apply.

Statement: Since participating in acudetox treatment I have experienced the following

changes:

___ A reduction in chronic pain

___ A reduction in my levels of depression/anxiety

___ Feelings of guilt concerning my past behavior have lessened.

___ My cravings for alcohol/drugs have lessened.

___ I am in better control of my anger.

___ I am more at ease in my interactions with others.

___ I find it easier to participate in peer group therapy.

___ I worry less about trivial things.

___ My fears have diminished ___ a little ___ greatly.

___ I find I am more accepting of my substance abuse problems.

___ I feel better about myself.

___ My self-esteem has improved.

___ Hostility towards others has diminished.

___ My resentments have decreased.

___ My sleep pattern has improved.

___ My thinking is clearer.

___ I feel less stressed.

___ My overall energy has improved.

___ Acudetox treatment has been very helpful.

___ Acudetox treatment has been a little helpful.

___ Acudetox treatment has been of no help.

Thank you for your participation in this survey.

______________________________ _____________________
Name Date
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B 3 - Client Handout

Acupuncture!!

…Acupuncture is the world’s oldest medical science. It has been around

for over 3,000 years.

…Chinese medical science holds that there is an extensive and complex

energy system that flows throughout the human body. When this
stream flows freely, the body is in balance and healthy. Interruptions
and blockages in this normally free-flowing energy stream causes
stagnation, illness, disease and discomfort. Simply stated, acupuncture
is a technique that helps get the energy flowing freely and restore
balance to the body. In terms of modern medicine, acupuncture creates
healing changes in the various functional systems of the body.

…Acudetox auricular (ear) acupuncture is based on the fact that there

are points for the entire body mapped out on the ear’s surface.

…the National Acupuncture Detoxification Association (NADA) has

developed a protocol to treat addiction using five points on each ear:

 Shenmen or Spirit Gate – used for calming and relaxing

 Sympathetic – used for relieving tension
 Liver – used to detoxify, as well as to relax and relieve anger and
frustration
 Kidney – used to strengthen the willpower and release unwanted
toxins
 Lung – used to help respiration, as well as for detoxification.
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Appendix C:
Acudetox Risk Management

Acudetox Risk Management

From its original inception as an alternative to medication-assisted detoxification at Lincoln

Hospital, the acudetox protocol is finding its way into a broad spectrum of clinical scenarios. As the
use of acudetox grows, it is important that all parties associated with the treatment – the clients as well
as those delivering, supervising, cleaning up after the treatment and the programs in which the
procedure is performed – remain safe and their risk of adverse events minimized.
While acudetox is generally considered a relatively safe procedure, as is acupuncture in
general, there are none-the-less certain inherent risks to which clients, Acupuncture Detoxification
Specialists (ADSes), acudetox supervisors, cleaning personnel and programs may be exposed. These
risks include accidental needle sticks, exposure to blood borne pathogens, adverse reactions to the
treatment (rare), improper staff responses to adverse clinical events, failure to obtain proper informed
consent and maintain patient confidentiality, improper disposal of used needles and failure to abide by
federal, state and local laws and regulations.
Fortunately there are established risk management strategies that can minimize if not
completely eliminate the chance of adverse events occurring in a NADA-style treatment
program.
In the event that an adverse event does occur, having written procedures in place and
maintaining rapport and open communications will lessen the potential for negative outcomes from the
occurrence.
Risk management is the process of assessing situations for potential risks and developing and
implementing strategies to manage and mitigate their occurrences. These strategies include avoiding
the risk, reducing the negative outcomes of the risk and accepting the consequences of the risk. For
acudetox programs this means:
 following Universal Precautions and Clean Needle Technique procedures,
 utilizing recognized engineering controls (e.g. sharps containers) and personal
protective equipment (where required or desired),
 obtaining explicit informed consent and assuring confidentiality of client records,
 establishing and maintaining proper rapport between the program staff and the
clients,
 having written supervision agreements in place (when supervision of ADSes is
required), and
 assuring ADSes and acudetox supervisors are able to identify and respond to adverse
clinical events.
Programs along with their acudetox supervisors and non-managerial ADSes must develop and
implement an appropriate Exposure Control Plan as required by OSHA. Programs must also provide
annual blood borne pathogens training to all personnel who have a reasonable risk of exposure to
contaminated acupuncture needles and other materials that may have become contaminated by a
patient’s blood or other body fluids. Programs, ADSes and acudetox supervisors must also be familiar
with and abide by federal, state and local laws as they pertain to the acupuncture in general and
acudetox in particular.
Before discussing how to establish risk management strategies within an acudetox program,
some background information will be presented. Acupuncturists, nurses, doctors and certain other
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healthcare professionals will likely be familiar with Universal Precautions, Blood borne Pathogens
and Exposure Control, and the Needlestick Safety and Prevention Act and can use this material as a
review of these concepts. For those not familiar with these topics, it is suggested that the reader
consult the references for more detailed presentations of this material or seek the advice of experts in
these areas. While not intended to be an exhaustive treatise on these subjects, the topics of needle
removal, client confidentiality, Informed Consent, medical histories, and ADS supervision are also
presented. The concept of a Risk Cascade is reviewed followed by strategies to reduce risks to the
clients, ADSes, supervisors and programs.
This information is provided as guidance and it is up to each program, ADS and supervisor to
adapt these concepts to the specific clinical scenario.

Background information
Universal precautions and blood borne pathogens
The Centers for Disease Control and Prevention (CDC) define Universal
Precautions as “a set of precautions designed to prevent transmission of human
immunodeficiency virus (HIV), hepatitis B virus (HBV), and other blood borne
pathogens when providing first aid or health care. Under universal precautions, blood
and certain body fluids of all patients are considered potentially infectious for HIV,
HBV and other blood borne pathogens” (Centers for Disease Control and Prevention,
2005). In other words, all human blood and certain other human body fluids are treated
as if known to be infectious for blood borne pathogens. While Universal Precautions
cover many types of body fluids, in acudetox settings blood is the fluid of concern as on
occasion clients’ ears may bleed after the removal of the needles (Universal Precautions
do not apply to sweat, tears, nasal secretions or saliva unless they contain visible
blood). Universal Precautions include the use of Personal Protective Equipment such
as gloves when there is a reasonable chance of the healthcare provider coming in
contract with clients’ body fluids or contaminated items (defined as “the presence or
reasonably anticipated presence of blood or other potentially infectious materials on an
item or surface”) as well as measures to prevent inadvertent needle sticks.
The Clean Needle Technique for Acupuncturists (CNT) is the recognized
standard of care for the acupuncture profession in regards to blood borne pathogens and
needle stick prevention (National Acupuncture Foundation, 1997). The 5th edition
includes special provisions for performing acupuncture in public health settings that
outlines specific modifications of the standard techniques. While this manual is the de
facto standard for the acupuncture profession, as will be noted shortly, programs are
required by federal law to abide by the regulations prescribed by OSHA and other
federal entities.
There are several factors that influence the overall risk of exposure to blood
borne pathogens including the number of infected individuals in the client population,
the pathogen involved, the type of exposure (e.g. needle stick versus skin contact), the
amount of blood involved and number of blood contacts (Centers for Disease Control
and Prevention, 2003). Several larger metropolitan areas report at least 90% of IV drug
users are positive for HBV, hepatitis C (HCV) and/or HIV. Even so, very few
exposures result in infection. Because acupuncture needles are solid (as opposed to
hollow-bore hypodermic needles), they carry very little risk of carrying infected blood.
With proper diligence inadvertent needle sticks with contaminated needles should never
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occur. Proper disposal of blood-contaminated items such as used cotton balls further
decrease the chances of blood borne pathogens exposure.
Because of the high occurrence of HBV infection among IV drug users, the
Centers for Disease Control and Prevention recommend universal HBV vaccination for
individuals who work in facilities in which these clients are treated (Center for Disease
Control and Prevention, Healthcare settings serving IDUs). Because the vaccinations
are given via injection and therefore considered invasive, programs cannot mandate that
their employees receive the vaccination series. ADSes are advised to consider the
vaccination series if they have not already done so.
ADS safety and exposure control
The Occupational Safety and Health Administration (OSHA) exists to assure
the safety and health of workers in the US. Because most ADSes are either employees,
consultants or volunteers of a program they fall under the auspices of OSHA
regulations (whereas self-employed, unincorporated, private practice acupuncturists and
other unincorporated healthcare providers with no employees or other persons
practicing in their offices do not). The blood borne pathogens standards are Federal
regulations (29 CFR 1910.1030) established by the Needlestick Safety and Prevention
Act (Congressional Record, 2000) and enforced by OSHA. These regulations apply to
all employers that have workers with reasonable expectations of occupational exposure
to blood or other potentially infectious materials (OPIM) (Office of the Federal
Register, 2006). Included in this standard is the requirement for a written Exposure
Control Plan that must include a system for reporting exposure, information on testing
for infection, treatment options available and monitoring for side effects of treatment
(certain smaller clinics may be exempt from keeping injury and illness records,
including sharps injuries logs, but are still required to otherwise be in compliance with
the blood borne pathogens standard). The full text of 29 CFR 1910.1030 including the
components of an Exposure Control plan can be downloaded from the Office of the
Federal Register’s website listed in the Reference Section.
As part of their Exposure Control Plan, programs along with their acudetox
supervisor and ADSes must evaluate the need for Personal Protective Equipment
(PPE), which for NADA style programs is generally limited to the use of gloves by
ADSes during needle removal. Factors to consider in whether to require gloves while
removing needles include the type and number of clients served and the experience of
the ADSes. Whether or not a program requires the use of gloves when removing
needles, OSHA requires that PPE be available for workers if they desire to use them.
While not legally considered PPE, closed-toe shoes should be worn by ADSes to
prevent inadvertent needle sticks from dropped needles.
Tuberculosis (TB) exposure is another concern in several metropolitan areas.
The Centers for Disease Control and Prevention suggest that programs develop a TB
exposure control plan designed to reduce the risk of TB transmission between clients
and patients. Staff should be encouraged and can be required to undergo regular
purified protein derivative (PPD) testing. Even very low risk programs should have a
written procedure for how to proceed if a client with known or suspected active TB is
encountered.
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Needle removal
The practitioner or the clients can remove needles. There are risks and benefits
of each model. (Programs will need to set policy/procedure that best suits their
situation.)
 Clients remove needles: Under supervision, clients remove their own needles
and staunch any bleeding that occurs (using either a cotton ball or a cotton-
tipped swab). It may be helpful to provide a station with a mirror, a biohazard
container, cotton balls/swabs and hand cleaner, and a system for counting
needles. Clients must wash their hands with soap and water, alcohol-based
hand rubs, antibacterial gel, wipes or foam after removing needles whether or
not there was visible blood present.
 ADSes remove needles: ADSes remove needles one at a time and put each
needle directly into the red sharps container watching it all the way into the
container. Whether or not the ADSes are required to wear PPE must part of the
program’s Exposure Control Plan. Cotton balls or cotton-tipped swabs must be
with the ADS. Give cotton balls to client to staunch bleeding or hold a swab on
the site for several seconds with firm pressure. If the ADS is wearing gloves
and any blood gets on them, the gloves must be disposed as outlined in the
program’s Exposure Control Plan and a fresh pair donned before going on to the
next client (please note that while they prevent contact with blood, gloves do
not protect against needle sticks). If the ADS gets blood on his or her hands,
then the procedures outlined in the programs Exposure Control Plan must be
implemented.

Client confidentiality
The implementation of the Health Insurance Portability and Accountability Act
of 1996 (HIPPA) is provided for in The Standards for Privacy of Individually
Identifiable Health Information (Privacy Rule). The types of programs (“covered
entities”) addressed in the Privacy Rule are, “any health care provider who transmits
health information in electronic form in connection with transactions for which the
Secretary of HHS has adopted standards under HIPAA” (Office for Civil Rights, 2003).
The type of “individually identifiable health information” protected under the Rule
(“protected health information”) includes any information that identifies or can be used
to identify the individual and relates to the person’s past, present or future mental or
physical condition or health and to the provision of or payment for treatment to the
individual. Even for programs that do not transmit data electronically, HIPPA and the
Privacy Rule have become the de facto standards for assuring confidentiality of patient
records. There are additional Federal Laws and Regulations that address the
confidentiality of addictions treatment records including 42 USC 290dd-3, 42 CFR Part
2 and 42 USC 290ee-4. These statutes prevent programs from confirming a person is a
client of a program unless the client gives written permission, the program is ordered by
a court or in the case of a medical emergency.
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Informed Consent
Because acudetox is considered an invasive procedure (i.e. the needles break the
skin barrier), clients must sign an explicit (written) informed consent prior to receiving
treatment. This informed consent must be made part of the clients’ files and may be
rescinded at any time. Failure to obtain informed consent prior to providing acudetox
treatment can be legally prosecuted as a form of battery (Wagner RA, 2006). Client
must voluntarily give their consents without duress or coercion.
For a patient to provide explicit informed consent he or she must exhibit the
competency (have the capacity) to do so. Legally this means the client must be able to
understand all of the options, the consequences of accepting each option and the
personal cost and benefit of accepting or declining each option. The acudetox program
must describe the treatment including the expected benefits and risks and the client
must be able to comprehend the information.
In many acudetox programs, treatment is delivered not only by acupuncturists
and ADSes, but also by individuals accumulating the required clinical hours to receive
their ADS Certificate of Completion. In these situations, the Informed Consent must
clearly state that the treatment may be provided by trainees/students in addition to
licensed acupuncturists or ADSes.
Medical History/Physical Exam/Physician Referral
Some states require that prior to receiving acupuncture treatments; clients must
give a medical history, have a physical exam, and/or have a referral from a physician.
Because acudetox is considered an acupuncture treatment, acudetox clients may fall
under these regulations. State laws must always be checked prior to initiating an
acudetox program including the need for medical history, exam and or referral.
Supervision
Most states that allow non-acupuncturist ADSes require supervision of the
acudetox treatment by either licensed acupuncturists or other healthcare providers
whose scope of practice allows them to practice acupuncture without supervision. In
several states the statutes places the burden of assuring that paperwork is maintained
according to established standards on the supervisor. Even in states where this
requirement is not specifically stated the supervisor may very well be considered the
“expert” and it is his or her responsibility to assure that proper risk management
measures are in place. In states where supervision is not required or where the ADSes
are acupuncturists or other healthcare providers whose scope of practice allows them to
practice acupuncture without supervision the impetus to assure safe and ethical use of
acudetox falls on them as well as the programs in which the procedure is being
performed.

Risk Cascade
As already indicated, risk management involves identifying potential risks and
minimizing, if not completely eliminating, their potential for occurrence. In other words, do no
harm while doing some good (which coincidentally is an underlying theme within NADA-style
treatment). There are certain dimensions of risk that need to be examined and planned for
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accordingly and these dimensions often fall into the following cascade of events (Kailin DC,
1997 pgs. 13 - 16):
 Material harm: the actual physical damage to the person.
 Perceived harm: the impression of the harm perceived by the individual.
 Relational failure: the failure to establish and maintain rapport. Rapport or the lack
thereof will generally affect the level of harm perceived by a person relative to the
actual material harm sustained.
 Consumer legal action: failure to establish and maintain rapport will often lead to the
individual perceiving much greater harm than actually materially occurred and may
lead to the consumer (client) seeking legal remedy against the ADS, acudetox
supervisor and/or program. Conversely establishing and maintaining rapport will often
have the client perceiving a lesser degree of harm.
 Regulatory action: failure to establish and maintain rapport can also result in
complaints to licensing bodies (e.g. state boards) by consumers that can lead to
investigations and sanctions against ADSes, acudetox supervisors and/or programs.
Programs can also institute sanctions against its ADSes and/or acudetox supervisors
based on internal complaints or observations.
 Repercussions: the negative outcomes to the ADSes, acudetox supervisors and/or
programs from legal and regulatory actions. These may include monetary costs and
fines, loss or restrictions of licensure, embarrassment to the individuals and the
programs, termination of acudetox treatment within programs and cancellation of
malpractice insurance.
The primary material harm risk involved with acudetox centers around the use of
acupuncture needles. Possible but rare risks to the client involve infection, inadvertently being
stuck with a contaminated needle, exposure to another client’s blood and injuries secondary to
an adverse reaction to the treatment (which are very, very rare). ADSes face risks from
inadvertent needle sticks and coming in contact with clients’ blood. In addition, cleaning
personnel can also be inadvertently stuck by a stray needle as can other staff or clients if the
acudetox room is used for other purposes. Fortunately the material harm aspect of risk can be
significantly reduced if not completely eliminated by following Universal Precautions, Clean
Needle Technique and the guidelines set forth in this manual as part of NADA ADS training.
Establishing and maintaining rapport with the clients will generally reduce the perception of
any material harm and therefore mitigate the chances of legal actions and regulatory
complaints.

Risk minimization
Minimizing risks within an acudetox program can also be viewed as a cascade.
Reducing the risk of material and perceived harm to clients is the most important aspect of a
Risk Management Protocol, followed by risk to the ADSes. Minimizing risks to these groups
will result in safe and effective NADA-style programs thereby mitigating risks to programs
themselves, program administrators and acudetox supervisors.
Minimizing risk to clients
 Clients should be reminded verbally and/or via posted instructions of the
program rules regarding client safety. New clients should be reminded before
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their first group needling session even if they received these instructions in an
orientation session. Program rules should include:
o not to play with any needles that fall out during treatment,
o to secure his or her own fallen needles in whatever manner the program
has established that protects others from contacting the contaminated
needles. (e.g. in carpet, through pants, in a safe, visible location, etc.),
o not to touch another client’s fallen needles,
o that there is no walking around while the needles are in,
o they are not to lie on the floor in the general area of where the needling
takes place. For clients with back problems, special arrangements can
be made for the client to lie down away from where he or she may
contact other clients’ fallen needles,
o Clients should be requested to use the restroom prior to treatment. If a
client does need to use the restroom during treatment, an ADS should
remove all needles and replace them with sterile, unused needles when
the client returns.
 ADSes must wash hands thoroughly before and after the treatment session with
both soap and water or with alcohol-based hand rubs. If these are not available,
then the ADSes must use antibacterial gel, wipes or foam. If the ADSes hands
become contaminated during needling, he or she must clean his or her hands
prior to treating the next client.
 Clients must prepare the surface of their ears with an alcohol swab or alcohol-
soaked cotton ball. Clients on disulfam/Antabuse can use a non-alcohol based
preparation or use soap and water.
 Use only pre-sterilized, single-use needles from unopened packages. Discard
any needles if the tips have touched any surface other that the intended ear point
and any unused needles at the end of the treatment day.
 ADSes must always follow the guidelines in this manual for proper needling
technique.
 While being needled sitting in chairs, clients must be sitting straight up with
both feet on the floor (once needles are in clients can adopt a more comfortable
sitting position).
 Used needles must go into a red sharps container.
 ADSes must follow the program’s Exposure Control Plan for disposing cotton
balls or swabs that have been used to absorb a patient’s blood.
 The ADSes and/or acudetox supervisor must check the room for stray needles
after each session.
 ADSes must be able to address adverse clinical situations such as:
o Deficiency/weakness: Clients who are extremely “deficient” or weak
may need a lighter treatment using seeds or fewer needles. For example,
clients who are HIV positive or pregnant or just off a long, hard run of
drug use may be weak and more sensitive to the needles.
o Fatigue/hunger: Encourage clients who are excessively fatigued to rest
and clients who are excessively hungry to eat. Some program supply
food. Others explicitly instruct clients to eat a light meal prior to
acupuncture treatment.
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o Broken skin or bruising: When clients have pimples, cuts, sores, rashes,
irritation, infection, bruises or hematomas (swelling containing blood),
etc. at the point location, do not needle that point until the site has fully
healed. If a client has a wart or scar tissue at a point location, likewise
do not needle it.
o Hemophilia: Clients who are hemophiliacs “bleeders” may still be
treated even though there is some bleeding possible when needles are
removed. Bleeding is minimal because of the minuscule size of the
needle hole. It is appropriate to ask such clients about their medication
compliance and monitor them more carefully. The same applies to
clients on anti-coagulation medications. However, these conditions are
not contraindications acudetox.
o High/intoxicated: Clients who have just used or are still very intoxicated
may not get as much benefit from the treatment.
o Fear of needles (Belanephobia): Clients with fear of needles may need
additional support in order to feel safe with the needling process. Allow
them to observe or speak with other clients. Breathing exercises and
options such as just trying one needle, sitting without needles or using
press seeds/balls can be helpful.
o Hering’s Law of Cure: a theory out of homeopathy in that as the body,
mind and spirit clear past trauma, a flare-up might very likely occur. If
so, it will happen in the first 24 – 48 hours after treatment, will not last
for more than 24 hours and will not be a new symptom. Rather than
viewing a symptom as a negative, the client should be instructed to view
it as part of his or her healing, that he or she is getting better. If the
symptom is new, or one that the client does not remember having before,
he or she should be instructed to contact a physician.
o Needle shock, postural hypotension, vagal reaction, needle sickness or
fainting:
 Although this rarely occurs ADSes must always look for signs
immediately after needle insertion.
 Symptoms include loss of color, sweating, dizziness, lightheaded
sensation, nausea and fainting.
 If a client feels faint or faints while sitting up, calmly remove the
needles, raise legs to a horizontal position and lower the head. It
is recommended that clients be placed safely on the floor if
possible (be sure there are no contaminated needles in the area on
which the client will by lying), making sure that the airways are
not obstructed.
 If client feels chilled, help him or her to stay warm.
 Symptoms resolve quickly and client will exhibit relaxed
behavior as if a full treatment occurred.
 Eating prior to treatment decreases the possibility of needle
shock even further.
 Do not attempt to needle again in the same day.
o Hematoma (swelling due to bleeding under the skin):
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 May occur when a needle is removed.
 Have the client apply pressure with a dry cotton ball.
o Needle through ear:
 May occur on insertion, particular in the liver point.
 Does not cause problems but may be disconcerting for the client.
 Adjust depth of needle insertion – review needling technique.
o Infection:
 Rare with proper infection control procedure.
 Do not needle the infected site until it has healed.
 Encourage client to clean and apply first aid or refer to medical
personnel.
o Headache:
 During treatment (headache that comes on shortly after insertion
of needles), remove or loosen sympathetic point.
 For post treatment headaches, first determine if this was a one-
time occurrence or if it has happened several times. If it occurs
after several treatments, do not insert the sympathetic point next
time. If this does not help then try reducing the length of the
treatment session.
Minimizing risk to ADSes
 Use Universal Precautions and prevent contact with blood and therefore any
blood borne pathogens. Wear gloves to cover any open sores/wounds on your
hands while needling.
 Consider gloving hands while removing needles even if the program’s Exposure
Control Plan does not require it.
 Wear closed-toe shoes at all times when needling or are in areas where needles
are being or have been inserted.
 Be mindful. Prepare the room ahead of time. Keep the work areas clean.
 Put all used needles into a red sharps container. Do not overfill containers.
 Follow the program’s Exposure Control Plan for disposing cotton balls or swabs
that have been used to absorb a patient’s blood.
 Use extreme care when retrieving fallen needles from surfaces to prevent a
needle stick. A magnet, hemostats or tweezers must be used to pick up stray
needles. Needles must be removed from a magnet with hemostats or tweezers
to prevent needle sticks.
 Carefully check the room for stray needles after each session.
 Consider being vaccinated against HBV infection.
 Be familiar with the program’s Exposure Control Plan and know what to do if
there is an inadvertent needles stick or other exposure to blood.
 Be sure to follow all state and local laws concerning supervision, the types of
clients that can be treated, the types of programs in which acudetox can be
performed by non-acupuncturist ADSes, treatment documentation, etc.
 Abide by the ADS Ethics Pledge.
 Limit acupuncture treatment to the five acudetox points unless otherwise
permitted by state or local statutes.
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 Establish and maintain rapport with clients at all times.
Minimizing risk to programs and acudetox supervisors
 Even if not required by state statute, have written agreements in place between
the program and supervisor and between the supervisor and ADSes and ADS
trainees outlining the responsibilities and duties for which each party is
responsible.
 Assure each client signs an informed consent and any other federal, state and
local forms required prior to receiving an acudetox treatment. For clients under
the legal age of consent (generally 18 years old), a parent or legal guardian must
give consent. In programs where ADS trainees are attaining clinical hours by
treating the program’s clients, the informed consent must clearly state that the
treatment may be provided by students/trainees.
 Establish and maintain security and confidentiality of client records, personally
identifiable health information and protected health information per federal and
state statutes.
 Assure that clients and ADSes follow the established guidelines as outlined
above, particularly those regarding Universal Precautions, ADS-client rapport,
and ethics.
 Develop and implement an Exposure Control Plan per 29 CFR 1910.1030(c).
By law input must be solicited from, “non-managerial employees responsible
for direct patient care who are potentially exposed to injuries from contaminated
sharps” (Office of the Federal Register, 2006: 21 CFR 1910.1030(c)(1)(v)) In
acudetox programs this most likely means the ADSes and cleaning personnel.
 Use only pre-packaged, pre-sterilized, single use needles for acudetox.
 Have gloves available for use when removing needles even if the program does
not mandate their use.
 Be sure all personnel who may come in contact with blood or be inadvertently
stuck with a contaminated needle receive proper training in Universal
Precautions and Blood borne Pathogens, are familiar with the Exposure Control
Plan and attend annual refresher courses.
 Have liability insurance protection in place specifically for acudetox.

References
California Department of Industrial Relations (2001). The Exposure Control Plan for Blood
borne Pathogens. CDE Press, California Department of Education.

Centers for Disease Control and Prevention (2003). Exposure To Blood. What Healthcare
Workers Need to Know.

Centers for Disease Control and Prevention (2005). Universal Precautions for Prevention of
Transmission of HIV and Other Blood borne Infections Fact Sheet.

Congressional Record (2000). Needlestick Safety and Prevention Act. Public Law 106-430,
106th Congress
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Training Resource Manual © NADA 2017 Section XI: Appendices 154
Kailin DC (1997). Acupuncture Risk Management. Corvallis, OR: CMS Press.

National Acupuncture Foundation (1997) Clean needle technique manual for acupuncturists:
guidelines and standards for the clean and safe clinical practice of acupuncture.
Washington, DC: National Acupuncture Foundation.

Office for Civil Rights (2003). Summary of the HIPPA Privacy Rule. Rockville, MD:
Department of Health and Human Services..

Office of Applied Studies (2002). National Survey of Substance Abuse Treatment Services (N-
SSATS): 2000. Data on Substance Abuse Treatment Facilities. DASIS Series: S-16.
DHHS Publication No. (SMA) 02-3668. Rockville, MD.

Office of the Federal Register (2006). Code of the Federal Register 29 CFR 1910.1030.
Washington, DC: US Government Printing Office Website:
http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&
p_id=10051 - 1910.1030.

Wagner RA (2006). Informed Consent. Retrieved November 10, 2007, from eMedicine Health
Website: http://www.emedicinehealth.com/informed_consent/article_em.htm.

Compilation of research and information: David Wurzel, LAc

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Appendix D: Research
D1
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D2
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Appendix E
Excerpts from Treatment Improvement Protocol (TIP) 45
The Center for Substance Abuse Treatment (CSAT) of the Substance Abuse and Mental Health
Administration (SAMHSA) of the US Department of Health and Human Services regularly publishes
Treatment Improvement Protocol (TIP) manuals for service providers. TIPs are “best practice
guidelines for substance abuse disorders” (Center for Substance Abuse Treatment 2006). TIP 45,
Detoxification and Substance Abuse Treatment, published in 2006, includes references to the use of
acupuncture in programs that provide such services. Following are pertinent excerpts from the TIP
(Copies of the entire TIP may be obtained free of charge from SAMHSA’s National Clearinghouse for
Alcohol and Drug Information (NCADI), (800) 729-6686 or (301) 468-2600; TDD (for hearing
impaired), (800) 487-4889, or electronically through the following Internet World Wide Web site:
www.ncadi.samhsa.gov.)

Chapter 3—An Overview of Psychosocial and Biomedical Issues During Detoxification

Strategies for Engaging and Retaining Patients in Detoxification

Consider Alternative Approaches

Alternative approaches such as acupuncture are safe, inexpensive, and increasingly popular in
both detoxification and substance abuse treatment. Although the effectiveness of alternative
treatments in detoxification and treatment has not been validated in well-controlled clinical
trials, if an alternative therapy brings patients into detoxification and keeps them there, it may
have utility beyond whatever specific therapeutic value it may have (Trachtenberg 2000).
Other treatments that reside outside the Western biomedical system, typically grouped together
under the heading of Complementary or Alternative Medicine, also may be useful for retaining
patients. Indeed, given the great cultural diversity in the United States, other culturally
appropriate practices should be considered. (pg. 34)

Chapter 4—Physical Detoxification Services for Withdrawal From Specific Substances

Alternative Approaches
Alternative methods that have been studied scientifically do not claim to be stand-alone
withdrawal methods, nor stand-alone treatment modalities. Alternative approaches are
designed to be used in a comprehensive, integrated substance abuse treatment system that
promotes health and well-being, provides palliative symptom relief, and improves treatment
retention. Therefore, because isolation of any of these approaches as an independent variable in
rigorous controlled studies is difficult, if not impossible, there are no conclusive data on the
effectiveness of alternative methods (Trachtenberg 2000).

Auricular (ear) acupuncture has been used throughout the world, beginning in Hong Kong, as
an adjunctive treatment during opioid detoxification for about 30 years. Its use in the United
States originated in California (Seymour and Smith 1987) and New York (Mitchell 1995) but
has not been subjected to rigorous controlled research. One report (Washburn et al. 1993)
noted that patients dependent on heroin with mild habits appeared to benefit more than those
with severe withdrawal symptoms, which acupuncture did not alleviate. The 1997 National
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Institute of Health Consensus Statement on acupuncture stated that acupuncture treatment for
addictions could be part of a comprehensive management program. The National Acupuncture
Detoxification Association has developed acupuncture protocols involving ear acupuncture in
group settings that originated at Lincoln Hospital in the Bronx and are used by over 400 drug
treatment programs and 40 percent of drug courts. SAMHSA’s National Survey of Substance
Abuse Treatment Services (NSSATS) found that 5.4 percent of the 13,720 facilities polled in
2001 offered acupuncture as a service (Office of Applied Studies 2002 b).

Acupuncture is one of the more widely used alternative therapies within the context of
addictions and behavioral health treatment. It has been used as an adjunct to conventional
treatment because it seems to reduce the craving for a variety of substances of abuse and
appears to contribute to improved treatment retention rates. In particular, acupuncture has been
viewed as an effective adjunct to treatment for alcohol and cocaine disorders, and it also has
played an important role in opioid treatment (i.e., methadone maintenance). It is used as an
adjunct during maintenance, such as when tapering methadone doses. The ritualistic aspect of
the practice of acupuncture as part of a comprehensive treatment program provides a stable,
comfortable, and consistent environment in which the client can actively participate. As a
result, acupuncture enhances the client’s sense of engagement in the treatment process. This
may, in part, account for reported improvements in treatment retention (Boucher et al. 2003). A
1999 CSAT-funded study showed that patients choosing outpatient programs with acupuncture
were less likely to relapse in the 6 months following discharge than were patients who had
chosen residential programs (Shwartz et al. 1999).

Ear acupuncture detoxification, which was originally developed as an alternative treatment for
opioid agonist pharmacotherapy, is now augmenting pharmacotherapy treatment for patients
with coexisting cocaine problems (Avants et al. 2000). The advocates of acupuncture have
joined with the advocates of opioid agonist pharmacotherapy to create a holistic synthesis.
Each has contributed to the success of the other, both clinically and in public perception.

Care must be taken to ensure sterile acupuncture needles in the heroin-dependent population,
given the high incidence of HIV infection, viral hepatitis, and other infections. Acupuncture is
not recommended as a stand alone treatment for opioid withdrawal.

Other alternative management approaches that are not supported by controlled studies include
neuroelectric therapy (the administration of electric current through the skin) and herbal
therapy. In fact, the former has been shown to be no better than placebo in a controlled study
(Gariti et al. 1992). The use of herbs for healing purposes dates back to the dawn of
civilization, while the use of herbs in the treatment of substance abuse has been documented
since 1981 in methadone programs, free clinics, therapeutic communities, outpatient programs,
and hospitals (Nebelkopf 1981). Herbal remedies are used in substance abuse detoxification
and treatment in a number of cultures around the world. However, in no scientific studies have
herbs been isolated as a discrete variable to test their efficacy. Much research is currently being
conducted on the effectiveness of herbal medicine on a wide variety of physical conditions.
(pgs. 103-104)

Considerations for Specific Populations

People With Disabilities or Co-Occurring Conditions
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There are a number of alternative treatments for chronic pain. Acupuncture is already in use in
some treatment programs for detoxification to help relieve symptoms of withdrawal. Physical
therapy and exercise, chiropractic care, biofeedback, hypnotism, and therapeutic heat or cold
are some other approaches to caring for persons with physical problems. Most of these
alternative treatments have limited or no research support of their efficacy; yet some clinicians
believe they work. Thus, consultation with experts on their use is necessary before starting a
person with chronic pain on these remedies. (pg. 113)
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Appendix F: Special Populations
F 1 - Women
Lincoln Recovery Maternal Substance Abuse Services – Raising Healthy Babies

In October of 1986 staff at Lincoln Recovery noted an obvious increase in the number of women
attending the program, primarily for “crack” addiction. A women’s contingent was implemented in
order to relate exclusively to women’s issues. The six-week program was designed to be convenient,
attractive to women and “workable”. A 10-day mandatory detox period, with no unrealistic excused
absences, is the initial phase of the program. Women are expected to call in if they are unable to
appear due to court appearances or other accountable reasons for missing.

The clients receive acudetox; have daily urinalysis and crisis counseling. The staff notes that in depth
counseling during the first 10 days in inadvisable, and instead provides that time frame as an
acclimation period for clients to become comfortable with the clinical setting and receiving acudetox.

Women are responsible for connecting with a counselor following the 10 day detox phase. The
program specifically does not chase clients or try to coerce them into treatment or providing urine
specimens. Noting that many support systems have a way of making women “act like children”, the
staff encourages women to work the program from a perspective of autonomy and responsibility,
especially since many of them have children of their own to raise.

Results of the urinalysis profiles determine the phases of progress through the program. A report of all
clean urines results in a time commitment decrease to twice per week. If there are some positive
urinalysis results, the counselor works with the client to set up a schedule and design the treatment
process according to the situation and needs of the client. The women are required to take acudetox
and leave a urine specimen at each treatment visit. Crisis counseling often plays a large role in the
treatment plan.

The Child Welfare Administration is responsible for approximately 80% of the treatment referrals to
the women’s program. Because of that agency’s participation, some of the women stay in the program
for as long as 6 months. The longer time frame allows for better monitoring and supports a stronger
recovery. The agency’s relationship with Lincoln Recovery is mutually cooperative and successful
recovery often results in the women having their children returned to family custody.

Program Design

Lincoln Recovery’s Maternal Substance Abuse Program takes walk-in clients and provides on-demand
treatment services. Although there are appointments given for intake, the women are encouraged to do
daily acudetox/urinalysis, even during the time prior to the completion of their intake appointment.
Each client must attend orientation classes, which are available each morning to facilitate
participation.

Narcotics Anonymous meetings are held daily. The Women’s Narcotics Anonymous meeting is
mandatory, and attendance is taken with a six-session requirement. The Women’s Rap Group is also
mandatory and offered weekly. A wide range of issues are discussed, including safe sex, AIDS, etc.
The women must attend six sessions in order to complete this phase of their treatment program.
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Time commitments are considered within the treatment design. From start to finish, the acudetox
session may take approximately one hour. Additional interactions, such as counseling sessions may
add up to about two hours of total program time for each visit.

Women are allowed to bring their children with them to the program, and a hands-on parenting skills
program helps increase their abilities. There is a non-judgmental atmosphere, which allows the
women to realize that the program staff is sincere in their commitment to support progress. Recovery
tends to be successful in this kind of supportive atmosphere. Women may repeat the program if they
are not successful in maintaining sobriety.

Lincoln Recovery was the first drug treatment program to offer a prenatal clinic, with a midwife
available one day per week. Prenatal education is provided and referrals made when necessary.
Educational videos regarding safe sex, AIDS, pregnancy and other topics are shown daily.

Prenatal clients are required to attend acudetox twice weekly until they deliver. Early statistics
showed an average of 65-70% clean urinalysis results after three months of treatment.

Women often have specific challenges in getting to and maintaining treatment. Addressing their
issues and allowing for easy access to treatment has shown an increase in treatment compliance.
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Special Populations
F2 - ADD/ADHD
Dustin’s Story
The following is a story of one mother, her search for treatment and her success with acupuncture:

I am a nurse and an Acupuncture Detoxification Specialist. My husband and I have three sons, James
17, Dustin 15, and Douglas 6. My husband and I grew up on farms in the Midwest and remained in
the area until 1996. Then our lives changed. My husband was offered a job with a competing firm,
and we chose to move closer to the metropolitan area. Our main concern with relocation was our
children’s education, mainly for our middle son, Dustin.

At six months of age, we knew Dustin was delayed and began taking him to the best doctors in the
state. Many times we traveled 150 miles to the University Hospital. During a period of several
months and after several trips, which took three hours each way, we were told Dustin would never
walk or talk. With occupational therapy and a lot of hard work, Dustin was walking unaided at age 20
months. At age four, after repeated trips to the doctors for tonsillitis and ear infections, he had a
tonsillectomy and adenoidectomy which helped him to breathe and talk more clearly. Again with
occupational therapy, his vocabulary increased. However, he was an angry child, always on the go,
destroying anything in his way and making family life unbearable.

Then, we were referred for physical and psychological testing for our son. We were willing to do
whatever it took to help him. He hated to be touched, had verbal outburst, had no sense of danger and
an attention span of less than five seconds. Our first appointment was at 8:00 a.m. After a two hour
trip, we waited in the waiting room for another two hours. By the time we say the doctor, we were all
hungry, tired and angry. After one hour of testing, Dustin was put on 30 mg. per day of Ritalin at four
years of age! Many old problems disappeared. Now, we had a child who did a lot of sitting and not
much of anything else. He was still very angry and when the medication wore off in the evening, he
was gorging himself with food, restless, tearful and unable to sleep.

Of course, we sought alternatives. We did allergy testing. He was put on a special diet and had
injections. There was no improvement but a lot of work. Every physician we saw sent us to someone
else. So more and more medications and treatments were added according to whatever their specialty
was.

When Dustin began school, a whole new set of problems developed. We discovered our educational
system for children with disabilities is virtually nonexistent in some areas. The main goal of the
school for Dustin was for him to sit in the back of the class and remain quiet. Well, the medication
sure did that. Year after year was a battle. We wanted him to be educated. They wanted him out of
the way.

Then we relocated. This was a hard decision for us. We had to leave the only home we’d known,
friends and family, and seek a school we thought would be beneficial. When Dustin began 8th grade
his curriculum was modified to his level and increased at his pace. Still, the teachers kept saying he
was tired and withdrawn from the other children. We felt it was due to the Dexedrine he’d been
switched to after a bout of depression he’d experienced two years prior to our move. That’s when
Lithium and Catapres came into the picture.
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In November of 1996, I accepted a job as a Detox Nurse in a small, rural town. Only having prior
experience with medical/surgical and geriatric nursing, I felt I had a lot to learn. As the months went
by, I saw withdrawal constantly on the job and when I got home, I saw my son going through
withdrawal every night. They were so similar that it was obvious to me why my son was so tired,
withdrawn and subservient all day and just the opposite at night.

In May, I volunteered to attend acupuncture training to help with withdrawal symptoms in detox. I
came home and practiced on my family so I could perfect my technique before taking the test.
Something totally unexpected happened. Dustin fell asleep during the treatment after about 5 – 10
minutes. I spoke to our family physician and our company physician and was encouraged to continue
and to document. With each treatment, it was the same. I even did a treatment on him while friends
were visiting and Dustin was very hyper. Again, he began to relax and settle down. Our friends were
amazed, as were we. Dustin began to ask for the treatment in the evening. So, I began regular
auricular acupuncture treatment using the five points I had learned. My son was taking Catapres 0.1
mg. twice per day, Lithium 950 mg. daily and Dexedrine 40 mg. daily. We did treatment one time per
day for the first week; then, two times per week for one week with seeds on at all the other times; then
one time per week for one week with seeds in-between placed on the same spots of the ear to provide
sustained acupressure. The Vaccaria seeds stimulate the area because they cause a mild irritation.
They generally go unnoticed and can be left in place, held on by surgical tape, for 3 to 5 days.

Dustin’s blood pressure was reduced enough to discontinue the Catapres slowly over two weeks’ time.
The depression subsided almost immediately with needling and the Lithium was discontinued over a
period of two weeks also. The Dexedrine was reduced slowly over a period of one month with a
teacher’s response being – handwriting improved, self-esteem increased, more alert and sociable.

He now takes 10 mg. tablets of Dexedrine at 6:30 a.m. which he asks for, stating, “It helps me in the
morning.” So that he will not be hungry, we are working out a snack midmorning and reducing the
Dexedrine. His weight has increased, some of which is normal for him when school begins. His
blood pressure is 130/86 and there are no signs or symptoms of depression. His sleep pattern is greatly
improved along with his self care and he has made friends in his school without teacher or parent
intervention. His grades are equal or better compared to last year.

I can definitely say the tone of our household is 80% improved due to his better behavior. His is more
alert and has a fantastic personality and sense of humor. There are no more angry outbursts and less
destruction of property. The family is much closer after the use of acupuncture because there is a
sense of calm we have not experienced in fifteen years since he was born. We were always “waiting
for the next storm” or problem to arise. He was always the center of attention.

Periodically he will ask for a treatment or seeds in his ears when he has trouble sleeping. I will
continue to needle him on an as-needed basis to maintain him at this level. He is a much happier child
since beginning acupuncture. Now, he is not scolded constantly or punished because of his behavior –
he is accepted and enjoyed. We feel we have finally unleashed his true personality – not a drug
induced one. He has been on medication since he was four years of age and that’s okay because that is
all we had access to. Someday he may need medication again, but for now it is working and we are all
benefiting.
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Special Populations
ADD/ADHD

The Reed Academy Experience

(NADA Conference, March 8, 2003, Washington, DC, Michael Smith)- the use of gold magnetic beads in the treatment of boys with ADHD, bipolar
and Asperger’s syndrome

Reed Academy is a widely acclaimed residential school for boys with serious behavioral health
problems. Under the supervision of Dr. Ed Cohen, director of Reed Academy, and Mary “Penny”
Mortensen LPN, the Reed school nurse, Christine Lee, RNCS, Lic. Ac., and Janine Agoglia conducted
a 6 week pilot study using one gold magnetic bead placed in the posterior shenmen position on each
ear. The project was suggested by Dr. Michael Smith of Lincoln Hospital (Bronx, NY) who has
previous experience with this type of treatment. The beads provide an acupuncture-like effect. The
following data summarizes the response of all 13 boys in the study. The name, age, diagnosis, test
response, and clinical response are listed. Test response is based on a modified Conners test which has
12 items which were graded from 0 to 3 in order of severity. The first number represents the score at
the beginning of the study as reported by teachers, nurse, parents and child care workers. The second
number is the score recorded at the end of the 6 week period. Most of the boys are on several
medications. Medications were not changed during the study.

Case-1 (age 13) PTSD, conduct disorder (20-15) – improved relationships; less fidgeting; did better
than his score indicates because he was noted to deliberately behave poorly while being observed. Due
to his previous history, Case-1 enjoyed the negative attention.

Case-2 (age 15) ADD, PDD (21-6) – greatly reduced excess movement and impulsive behavior;
improved concentration; better at relationships; “I no longer feel the high energy that made me move
all the time”; Case-2 asked to continue wearing the beads after the study was completed and still wears
them 1 year later; his mother has felt unable to handle her son at home for the past 6 years, now she
feels confident to have her son return home.

Case-3 (age 14) Aspergers, non-verbal learning disorder (20-13) – has improved slowly over time; was
able to listen and think more carefully; less fidgeting; finally able to “dismantle” part of his fantasy
world.

Case-4 (age 14) ADHD, ODD (22-11) – definitely less fidgeting; parents note improvement. More
cooperative on the weekends; able to work on craft projects using electric tools without fear by parents
of intentional self injuries.

Case-5 (age 13) bipolar, borderline MR (18-17) – more verbal; little change noted.

Case-6 (age 13) PTSD, ADHD, PDD, attachment disorder (28-23) – less fidgeting, better organizing;
little change.

Case-7 (age 13) ADHD, bipolar, Asperger, tricolomania (21-10) – less fidgeting; stopped pulling his
hair almost immediately and retains a full head of hair, eyelashes, and eyebrows a year later.
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Case-8 (age 11) ADHD, bipolar, anxiety (22-11) – communicates better with parents; is able to go out
with family without causing a scene; less acting out in class; less running and climbing.

Case-9 (age 11) bipolar, excess control needs (17-7) – mother finds him more relaxed; communicates
better; Case-9 felt like “beads were in control” and dropped out of the study after four weeks;
nevertheless the improvement continued.

Case-10 (age 10) bipolar, Aspergers, ADHD, borderline MR (20-18) – more in touch with feelings;
more warm; better at relationships and sticking to activities.

Case-11 (age15) ADHD, bipolar, introvert, very depressed (no score) – finally able to divulge
sensitive material; Case-11 dropped out after 4 weeks because he felt the “beads were controlling
him”; nevertheless the improvement continued; he is now doing well in a more main stream school.

Case-12 (age 14) bipolar, PTSD, schizoid, ADHD (no score) – rapid improvement in anger
management and constant hair twirling; dropped out because he transferred to a more mainstream
school where he is doing well; Case-12 was started on a new experimental medication during the study
period.

Case-13 (age 13) PTSD, OCD, ADHD, schizoid (no score) – dropped out in the middle of the study
because he felt a “loss of control”; nevertheless he has handled difficult family turmoil much better
than was to be expected.

Most of the boys seemed to have had a significant sustained improvement as a result of the bead use.
Reed Academy has a capacity of 25 students. All parents were offered the opportunity for this study.
Fourteen gave consent. Nine completed the study, although it seems clear that several of the drop outs
also had a significant experience. The option was given to the parents to also wear the beads while
their sons were in the study, six parents wore them for three (3) weeks and each noted a difference in
how they managed their own stress.
Acupressure treatment such as this protocol helps a person help himself. It is an adjunctive treatment
that seems to help the patient tap into a reserve capability for balance and rejuvenation. Similar
treatments are used widely for addiction, traumatic stress, and serious mental illness. This treatment
seems to enhance other psycho-social components so that these treatment effects might be more
evident in a high quality supportive environment such as Reed Academy.
The beneficial effects of the bead treatment seemed to begin within the first week of treatment. These
effects often continue for years later even though the beads may be used for six weeks only. The bead
treatment seems to initiate a reparative process that does not necessarily need prolonged stimulation to
be effective. Joanne Lenny, a Lincoln Hospital volunteer, has shared with us two remarkable success
stories (one with congenital nystagmus and the other a three year old with autism) in which several
weeks’ bead treatment led to seemingly permanent improvement. We did not expect these results.
Clearly there is a great deal to learn about the reliability and significance of these pilot study findings.
Our purpose is to share these tentative results.

To learn about this treatment in general contact Michael Smith at Lincoln Hospital, 718-993-3100, x 113. To learn about
this pilot study contact Christine Lee at 508-596-4680. Mary (Penny) Mortenson of Reed Academy, 508-877-1222,
coordinated this study and provided the clinical insight about these boys that has been so valuable to us.
National Acupuncture Detoxification Association
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Special Populations:
F 3 - The NADA Protocol: Beneficial Effects Beyond Detox
Laura Cooley, L.Ac.
22 Forrest Tallman Rd, Orford, NH 03777
603 353 9893 email Lauramon@mindspring.com

Acupuncture has been employed since 1978 as an adjunct treatment for Substance Use Disorder in
some 700 Drug Treatment facilities around the world. The specific acupuncture treatment found most
effective is the NADA (National Acupuncture Detoxification Association) 5 point protocol, consisting
of 5 needles placed in each ear at specific points. This 5 point protocol has been found to reduce
cravings and reduce recidivism of substance abuse*. It is important to provide the body of knowledge
that has also developed as a result of the implementation of this treatment. What follows is a review
of recent studies, outcome data, client surveys, and collected information on effects noted to
accompany the reduced cravings and recidivism which are not yet in the literature. One study involves
full body acupuncture and has been included to show that the outcomes support what clients receiving
the NADA protocol report through client surveys. Each of these examples have unique aspects that
contribute to the picture of potential results of this treatment for a variety of populations.

* A synopsis of studies and published articles available at end of review.

Acupuncture and acudetox have been used in a variety of treatment settings for a range of presenting
problems including: Substance Use Disorder, Relapse Prevention, ADD, ADHD, Depression,
Anxiety, HIV and HIV prevention, sexual offenders and juvenile offenders. Results have shown that
participants experience less anxiety, depression, insomnia, increased concentration, a reduction in
anger and violent outbursts, reduced need for medication, and stabilization of emotional and mental
processes of the mentally ill. This is in addition to the already documented effects of reduced cravings
and withdrawal symptoms, greater rates of program compliance and completion, lower recidivism and
longer periods of sustained sobriety.

The reduction of anxiety, depression, insomnia and concentration demonstrated would suggest that the
NADA protocol would offer important benefits for anyone suffering from post traumatic stress
disorder, such as victims of violent crime, natural disasters, etc. The dramatic reduction in violence
among historically dangerous offenders makes a strong statement recommending acudetox as a
treatment of choice to reduce violence within criminal justice facilities, and for domestic violence
offenders, sexual offenders, parents found to be abusive to their children or anyone with a tendency
towards violence and poor
impulse control. The potential for stabilizing those living with ADD, some of whom who may also be
presenting violence and substance use disorder, may be quite high. It is also an effective tool for those
who do not seem to benefit from verbal methods of drug counseling, such as the mentally retarded or
others who have low verbal skills.

It appears that some of the most difficult factors which prevent effective treatment for substance
abuse, dual diagnosis, violent and sexual offenders, non compliance and resistance, leaving treatment
AMA (against medical advice), high levels of anxiety and fear, depression and lack of motivation,
physical debility (due to drug use or withdrawal), mental and emotional instability, inability to
concentrate and retain material, are addressed by this treatment.
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In light of the fact that the NADA protocol is ineffective outside of a drug treatment program and
counseling, it may be that using acudetox along with psychotherapy could yield more significant
results for treatment of depression. The effectiveness of pharmacological and psychotherapeutic
interventions for depression do not last, but it is possible that using acudetox with psychotherapy
would yield more sustained relief, without the expense and the considerable side effects of
pharmaceuticals, this could provide a more inexpensive, more effective and less intrusive form of
treatment for depression.

Since all manner of health care professionals can easily, safely and cheaply be trained to provide this
service within their scope of practice, integration into the public health care system could realistically
be obtained. This treatment lends itself well to the multidisciplinary treatment team approach that we
know is necessary to address the complexity of issues involved in, for example, dual diagnosis, and
would support the models of prevention and integrated treatment being proposed by federal and state
levels of government**. All members of the treatment team can be trained to deliver the treatment
protocol, leading to the ”barrier free” access to service necessary to obtain high levels of effectiveness.
It provides a useful tool that de-escalates crisis situations, that can be used on crisis intervention units
(Psychiatric Facilities) or travel to where the crisis is occurring (Street Outreach Programs).

One last mention of the NADA protocol is that staff also receive treatment. This enables staff to
receive all the benefits that clients also receive and helps to build more efficiency into the systems
providing care. In an arena where professionals, who bring with them a variety of disciplines and
educational backgrounds, are now having to work together, it provides common ground on which to
build bridges. It may be that this could be one of it’s most important and powerful functions.

**Crime-What Works, What Doesn’t, What’s Promising. A report to the United States Congress,
prepared for the National Institute of Justice; available @ web site:
http://www.ncjrs.org/works/index.htm)

Anxiety & Depression

Department of Psychology, University of Arizona

John J. B. Allen, Ph.D. (520) 621 0992
The Efficacy of Acupuncture in the Treatment of Major Depression in Women

The University of Arizona conducted a 2-year study on the effect of acupuncture on major depression
and found 70% of subjects remitted with 64% experiencing full remission of major depression. This is
roughly the same success rate as pharmacologic and psychotherapeutic treatments, which is an
important finding, since both pharmacology and psychotherapeutic interventions fail to provide lasting
relief.

It is estimated that 17% of the US population suffers from major depression. The costs of treatment
exceed those of other chronic illness such as diabetes or hypertension in terms of personal distress, lost
productivity, interpersonal problems and suicide.

Patients were included if they met DSM-IV diagnostic criteria for current Major Depression. To
assess the women’s depression, a modified version of the Hamilton Rating Scale for Depression was
used. Resting EEG was assessed every 8 weeks during the acupuncture treatment. Treatment
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performed was full body acupuncture, not the 5 point NADA protocol, but findings are consistent with
what acudetox clients report.

British Columbia Women’s Hospital, Aurora Centre

Nancy Poole, Principle Investigator (604) 875 2066

Evaluation Results Regarding Provision of Acupuncture as a Complementary Therapy for Women in

Addictions Treatment

This study, performed in a residential treatment center, found that clients who received acudetox
experienced a greater reduction in anxiety, depression, insomnia and concentration difficulties than
clients in the same group who did not receive acudetox.

Sacred Heart Rehabilitation Center, Inc. Memphis, Michigan

Opiate Detox and Stabilization Program (Inpatient Rehabilitation Facility)

Joyce Hartsfield, D.O. (810) 392 2167

According to a client survey administered over an 11 month period to clients receiving the 5 point
NADA protocol on average 7-10 treatments:

56% reported less anxiety

50% reported less depression
53% reported less insomnia

Doctors Hospital in Toronto

Tyrone Turner, M.D., Medical Director of Mental Health Services at Doctor’s Hospital in Toronto
(416) 530 6788

Pilot Project Study - Acupuncture for Women with Addictions

A Pilot Project Study in 1995-96 was conducted at Doctors Hospital in Toronto. Over the course of 20
weeks clients were assessed at intake, completed 6 client self-report questionnaires, Service Utilization
Questionnaire, Client Well-Being Questionnaire, Client Satisfaction Questionnaire, and measures were
taken using Centre for Epidemiologic Studies Depression Scale (CES-D) and Drug Avoidance Self-
Efficacy Scale (DASES).

The Pilot Project Study found that the NADA treatment significantly reduced depression and anxiety,
improved sleep and contributed to improvements in perceived well-being. The changes in these
conditions are also reflected by reduction in the frequency of use of most health and social services.
Reduced use of substances was another result. A cross over study design with randomization of
clients was employed.

Criminal Justice & Violence

Dartmoor Prison, United Kingdom Alan Dudley, Principal Officer

Margaret Pinnington, NADA Trainer 011-44-1202-398-460
National Acupuncture Detoxification Association
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Presented at UK NADA Conference 1998 by Alan Dudley

Acudetox programs were initiated at Dartmoor prison in May of 1997. Statistics were gathered from
two cycles of a series of treatments. Inmates received 4 weeks of acudetox treatments 5 x’s per week.
The Acudetox group was comprised of 75 inmates; the non acudetox group, 115 inmates. In the
acudetox group, 61 of 75 completed the recommended series of treatments, with those who dropped
out receiving only one or two treatments.

Treatment group (75 inmates) Non treatment group (115 inmates)

1rst cycle
intra prison charges 4 31
positive for drugs 1 11

2nd cycle
intra prison charges 1 12
positive for drugs 0 3

All inmates engaged in acudetox treatment were administered psych evaluations before and after
treatment series and showed positive change. During the 2nd cycle of treatments, all persons on the
unit showed improvement.

Roz Yates, RN from Elmley prison, primary site in Kent, reports that 1 year after initiating a
methadone treatment program, only 1 person has joined the program and all other inmates at Elmley
have utilized acudetox.

All 11 prisons in Kent are utilizing acudetox and prison officials note a decrease in staff absenteeism.
acudetox is currently being utilized in 2/3’s of the prisons in the UK.

San Francisco County Jail

George Jurand, RSVP Program Manager, County Jail #7, (650) 266 9339

The San Francisco County Jail has set up a special violent prisoner unit. The RSVP program (For
Resolve to Stop the Violence Project) is the first mandated, in jail, restorative justice project in the
country.

James Gilligan, MD, director of the Harvard University Medical School’s Center on Violence has
begun a formal, three year evaluation. To date, 700-900 violent offenders have passed through the
program with 300 staying for 30 days or more. A scuffle was reported in September of 1997, but no
fights have been reported since. Program administrator Sunny Schwartz reports that among the
general jail population, fights occur about 3 times per week.

Santa Clara County Department of Corrections

Prepared by Charlie Savoca, L.Ac. and Cally Haber, L. Ac. 408 479 3760

Evaluation Summary of Acupuncture Program

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Female inmates at Correctional Center for Women, Milpitas, California

Santa Clara County Department of Corrections evaluated, among other things, the effect the NADA
protocol treatments had on fear/paranoia, anger/resentfulness, anxiety, depression, and over-reaction in
inmates. All of the categories evaluated were reported to have been reduced in frequency among
inmates who received acudetox.

Denver County Jail, Project Recovery, Mile High Council

J. Oliva, Division Chief, Denver Sheriff Dept., County Jail Division
John Simonet, Director of Corrections and Undersheriff
Flavia Henderson, Executive Director of Mile High Council on Alcoholism and Drug Abuse, (303)
825 8113

In surveys of inmates who were given the acudetox protocol, 53% reported better health and attitude,
and for those who received 5 or more acudetox treatments, no Class I and II violations (fighting and
assault) were filed.

Sexual Offenders

Minnesota Corrections Facility, maximum security at Oak Park Heights

Pat Culliton, L.Ac. (612) 347 8559

Linda Leef, L. Ac., has been performing acupuncture treatment at a maximum security prison in a
treatment program for sexual offenders and addictions. She has recorded through client surveys a
reduction in their levels of anger, stress, intrusive sexual fantasies, and compulsive masturbation. Data
evaluation in progress.

Bob Fulton from The Meadows in Arizona found that when using acudetox with sexual addicts, the
“detox” from compulsive sexual behavior is virtually is identical drug detox. Ben Wharton of
Sweetwater, Texas has a 3 year sexual offender program and finds that it is as helpful for sexual
offenders as with his addiction clientele, and specifically that it breaks the denial sexual offenders
most often claim regarding their offenses.

ADD/ADHD

Case History
Cindy Briolet, Detox Nurse, Acupuncture Detoxification Specialist (810) 392 2167
Sacred Heart Rehabilitation Center, Memphis, Michigan

Cindy Briolet has a 14-year-old son, Dustin, who was diagnosed with ADD and put on Ritalin at the
age of four. He continued to take medications and more recently was prescribed Catapres, Dexadrine
and Lithium for ADD and depression. When Cindy Briolet was trained in the NADA protocol in 1996,
she administered needles on her son as practice of the technique. An unusual thing happened: Dustin
fell asleep. With repeated treatments, he not only continued to fall asleep, but he began to relax in
general. Dustin began to request treatments. Needles in the ear were supplemented by taping small
pellets onto the ear to continue stimulation of the ear points between treatments. In November 1997,
Dustin stopped taking all medications by his own request, and his depression, sleeplessness and high
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blood pressure no longer exist. His personal hygiene has improved and he no longer has angry
outbursts. He states “I feel calm, Mom, and I never feel calm”.
This has led to several pilot programs now underway in Michigan, Virginia and the Bronx

Virginia Commonwealth University

Neil A. Sonenklar, Principal Investigator through the National Institute of Health (Office of
Alternative Medicine)

Acupuncture Point Treatment for Attention Deficit Hyperactivity Disorder

available @ web site; http://altmed.od.nih.gov/nccam/cgi-
bin/research/search_advanced2.cgi#R21RR09463

Approximately 3 to 10% of school age children have ADHD. The usual treatment is the prescription
of stimulant drugs. Twenty five% of these children do not respond to this form of therapy and there
has been very limited progress in terms of the use of behavioral treatments for ADHD.

This study was designed to evaluate the effectiveness of placing a gold bead on one acupuncture point
on the ear. Seven children with a primary diagnosis of ADHD based on DSM-III-R criteria took part
in this double-blinded placebo control study with themselves as their own controls using a multiple
baseline design. The Conners Parent Scale, revised from the Conners Teacher Rating scale, was used
as the main outcome measure.

Results:
3 children showed improvement during treatment phase
1 showed improvement during placebo phase which continued into treatment phase
2 showed a worsening throughout experimental conditions
1 showed no change in formal data

It appears that this treatment is effective for some children with ADHD with minimal risk involved.
The results obtained in the previous (above) case study were obtained using first the NADA 5 point
protocol, and then switching to the gold pellet application. It is quite possible that significantly better
results could be obtained by first administering the acudetox treatment followed by application of gold
pellets, and should be investigated further.

Dual Diagnosis

Heart of Texas Region MHMR (Mental Health Mental Retardation)Center

Tom Atwood, LMSW, Caseworker Supervisor (254) 939 2915

Clients of this program are the most seriously affected by mental illness as indicated by repeated,
frequent hospitalizations, repeated arrests or community complaints to law enforcement officials, and
the inability to access needed social and treatment programs without continual assistance. A high
number also exhibit addictions to various substances. Soon after ear acupuncture treatments began,
staff, clients and family members noticed better sleep, reduced stress, better appetite, feeling more
relaxed, clearer mind and more energy. Over time, hospital admissions were reduced by 70% from the
number of admissions for the previous 3 years.
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A second group was formed from clients living at Lake Creek, a residential halfway house. Hospital
admissions were reduced by 80% from the rate of the previous 3 years. A third group was created of
clients who were presenting for crisis treatment, exhibiting acute and/or escalating psychiatric
symptoms, often leading to hospitalization. This group reduced its hospital admissions from 8 per
month for the previous 3 years, to 8 for the first 3 months of the program.

Due to external circumstances, this delivery of ear acupuncture was terminated. Caseworkers Gloria
Turley and Glenda Hamilton did follow up tracking on the Lake Creek group by surveying client
information for the year prior to and the three years following delivery of NADA-style treatment
services. Gains achieved with the protocol were maintained on average of 3 - 6 months after
discontinuation of service.

Admissions:
In the year prior to inclusion of the NADA treatment, 100% of the patients had been admitted
to the psychiatric crisis stabilization unit (CSU) at least once per quarter. During the time that
the NADA treatment was provided there were no long term care admissions to CSU, only one
short term admission lasting for 2 days***, and after treatment was discontinued, more than
half had been admitted.

There were 8 admissions for emergency community hospital placement (usually followed by
time in the Austin State Hospital) in the year preceding the inclusion of the NADA protocol,
none during the treatment period, and six patients requiring that level of care in the period
after.

During the period of time when the NADA protocol was administered there were no
admissions to the Austin State Hospital. Once treatment was discontinued, admissions
resumed, and eventually at the frequency that had been present prior to the inclusion of the
protocol.

Crisis Intervention:
The average weekly number of crisis interventions, which had dropped by two
thirds, returned to its original level of 3.5 per week.

Medications:
The review found that one half the patients increased medications two weeks
after the protocol was discontinued. One month afterwards, all patients had increased their
medications.

*** personal communication with Gloria Turley, Social Worker, MHMR

Retention Rates

Betty Ford Center

Gail N. Schultz, M.D., Medical Director 800 392 7540
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Betty Ford Center conducted a 6-month pilot study with inpatient heroin addicts. Administering the
NADA 5 point protocol resulted in a reduction of clients leaving Against Medical advice by
approximately 1/3****. This reduction was consistent over the average course of a 28-day stay.
**** Rate reduction obtained through personal communication with Dr. Schultz.

Kent/Sussex Detoxification Center, Delaware

Irene Rust (302) 422 8338

The Kent/Sussex Detoxification Center is a state agency that serves all 3 counties in Delaware and 9
counties in the state of Maryland as public detox for indigenous and non insurance carrying clients.

Outcome data is presented on 667 consumers who were eligible to participate, 89 % of whom received
acupuncture.

Of those who received acupuncture;

82% had continued sobriety at 3 months compared to 33% of non acupuncture consumers
87% were not readmitted to detox compared with 18% of the control group and
76% reported an improved quality of life, compared to 34% of the control group.

Leaving the program “Against Medical Advice” dropped from pre-acudetox program rate of
16.6 per month, to 9.8 per month.

Conclusion
The effects of the NADA protocol appear to be broad and far-reaching, making it an ideal tool for
addressing a multitude of interrelated societal problems. Further research and data collection are
necessary in order to educate agencies and policy makers, and to understand exactly how to effectively
employ this technique to the most positive benefit.

Bibliography
Bullock, M.L., Culliton, P.D., & Olander, R.T. (1989, June 24). Controlled trial of acupuncture for
severe recidivistic alcoholism. The Lancet, 1435-439.

Brumbaugh, A.G., (1993) Acupuncture: New Perspectives in Chemical Dependency Treatment.

Journal of Substance Abuse Treatment, Vol. 10, pp.35-43.

Konefal, J. (1994) The Impact of the Addition of an Acudetox Program to an Existing Metro-Dade
County Outpatient Substance Abuse Treatment Facility. Journal of Addictive Diseases, Vol. 13, #3,
pg 71.

Smith, M.O., M.D., (1998) Acupuncture in Addiction Treatment. Medical and Health Annual,
Encyclopedia Brittannica, Inc.
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Appendix G: Sample Program Forms
G 1 - Confidentiality of Client Records

Federal Laws* and Regulations** protect the confidentiality of patient/client records maintained by
this program. No information regarding program participation or other data may be disclosed to any
person for whom express permission has not been granted via one or more of the following means:
 Consent in writing.
 Disclosure is allowed by court order.
 Disclosure is made to medical personnel during a medical emergency or to qualified personnel
for research, audit or program evaluation.

Violation of the Federal Laws and Regulations by a program is a crime. Suspected violations may be
reported to appropriate authorities in accordance with Federal Regulations. Federal Laws and
Regulations do not protect any information about a crime committed by a patient/client either while in
attendance of the program or against any person who works for the program or about any threat to
commit such a crime.

Federal Laws and Regulations do not protect information about suspected abuse or neglect from being
reported under State law to appropriate State or local authorities.

As a healthcare provider, the program is also required to maintain and use healthcare information as
defined in the Privacy Rule of the Administrative Simplification provisions of the Health Insurance
Portability and Accountability Act of 1996. A copy of the program’s Notice of Privacy Practices is
provided and available.

I have read, or have had read to me, and understand the foregoing pertaining to the
confidentiality of my treatment/participation records maintained by this program and have been
provided with a copy of the program’s Notice of Privacy Practices. Any comments I may have
or requests to restrict disclosures of my healthcare/participation information are as stated
below:

__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

___________________________________ ________________________________
Client/Participant Name Social Security or other I.D. number

___________________________________ ______________________
Client/Participant Signature Date

___________________________________ ______________________
Witness Signature Date

*Federal Laws: 42 USC 290dd-3; 42 USC 290ee-3

**Federal Regulations: 42 CFR Part 2
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Sample Program Forms:
G 2 - Client Consent to Treatment

Treatment Description
Acudetox is performed by placing thin, sterilized needles onto the surface of the ear. The treatment takes 45
minutes. Acudetox is usually done in a group setting. Treatments are provided by an Acudetox Specialist
(ADS) or a professional acupuncture practitioner or supervised trainee.

Possible Benefits of Treatment

The use of acudetox for detoxification, recovery support and relapse prevention has been shown to be helpful in
relieving acute symptoms of withdrawal from a variety of substances. Individuals often feel immediate relief
and a decrease in tension and anxiety. Further treatment may reduce such withdrawal symptoms as profuse
sweating, headache, body ache, stomach pain, runny nose, drug dreams and cravings. Participants may develop
a greater sense of and connection with themselves.

Voluntary
I hereby voluntarily consent to be treated with acudetox. I understand that I may be treated with acupuncture
needles and/or with the application of acupressure to the skin.
I have not been guaranteed any specific outcomes concerning the uses and effects of acudetox. I understand
that I am free to discontinue acudetox treatment at any time. However, I further understand that choosing to
discontinue treatment may have an effect on my program status.

Possible Side Effects/Healing Reactions

I understand that acudetox may result in certain side effects, including local bruising, slight bleeding, fainting,
temporary pain and discomfort, and temporary aggravation of symptoms existing prior to treatment.
Conventional medicine therapy also may be indicated, either in response to an emergency or as deemed
necessary at the discretion of a licensed health care practitioner.

Medical Referral
I understand that if there is a worsening of an ailment or condition, or if a new ailment or condition arises, I
should consult a licensed physician. I also understand that if I am currently under a physician’s care, I should
continue as long as my physician and I deem it necessary. This program does not recommend altering
medications or other therapies without first consulting my personal physician or health care provider.

Infectious Disease/Clean Needle Procedures

I understand that there are infectious diseases which have the potential to be carried through the air, through
physical contact, and through body fluids. I understand that ADSes/acupuncture practitioners follow
universally prescribed precautions to guard against the spread of infection.
In the case of blood-borne infections, such as hepatitis or HIV, I understand that the acudetox providers of this
program follow strict precautions and use only sterilized, prepackaged, disposable needles. The acupuncture
needles that are used for this treatment are single-use and applied according to nationally-based professional
standards.
I further understand that I am responsible for cleaning my ears with sterile alcohol pads or other skin cleansing
agent prior to acudetox treatment and that the treatment center will provide these supplies.

_____________________________ ____________________________ __________

Client Name Client Signature Date

_____________________________ ____________________________ __________

Witness Name (printed) Witness Signature Date
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Sample Program Forms:

G 3 - Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED
AND DISCLOSED BY THE PROGRAM/TREATMENT PROVIDER AND HOW YOU MAY GET
ACCESS TO THE INFORMATION.
PLEASE REVIEW IT CAREFULLY.

Use and Disclosure of Health Information

The program/treatment provider may use your health information, information that constitutes
protected health information as defined in the Privacy Rule of the Administrative Simplification
provisions of the Health Insurance Portability and Accountability Act of 1996, for the purposes of
providing treatment to you, obtaining payment for your care and conducting health care practices.
Treatment – Your health information will be recorded and used to determine the course of treatment
that should work best for you. The sharing of your health information may include other health care
providers involved in your care.
Payment – Your health care information may be used in order to receive payment for services. A bill
may be sent to either you or a third-party payer with accompanying documentation that identifies you,
your diagnosis, procedures performed and supplies used.
Health Care Practices – Your health care information will be used as necessary in order to improve the
quality and effectiveness of the care and services provided. For example, your case may be discussed
with another health care provider for increased understanding of your unique situation.
Appointment reminders – You may be contacted with appointment reminders. Please annotate
program records with any limitations requested.
Treatment Alternatives – You may be contacted with information about treatment alternatives and
other health-related activities that may be of interest to you.
Program Information Dissemination – You may be contacted to inform you of new services that are
offered or of events that the program is hosting or attending.
Communications with Family – In an urgent situation, a family member, significant other, or close
personal friend; identified by you; may be given information relevant to your care.
Research/Education – Your information may be disclosed to researchers or educators upon the
assurance that protocols have been established to assure the privacy of your health information.
Law Enforcement – Your health information will be disclosed when required under Federal, State or
Local law.
Other than so stated, the program agrees not to use or disclose your health information without your
written authorization. Other than activity that has already occurred, you may revoke this authorization
in writing at any time.
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Appendix H:
Selected Monographs on Addiction and Recovery
H 1 - Brain Disease Model of Addictions

Among the many difficulties faced in substance abuse treatment of any kind is the oft-held
prejudice that the addict is just a morally weak individual who chooses not to control his or her
compulsive behavior. Compelling research, performed in this country primarily by or under the
auspices of the National Institute on Drug Abuse indicates that addictions is actually a brain disease in
that many individuals have a genetic propensity to become addicted to one or several substances
and/or behaviors. Other studies clearly show that even if an individual does not have the genetic
predisposition for addictions, substance use and abuse can permanently alter brain chemistry and
function.
So if addiction is a disease, then why have treatment? The answer is simple, because it is a
treatable disease just like diabetes and heart disease. It is fairly well known that both of these common
maladies carry genetic components and through lifestyle changes (and when appropriate
pharmacologic interventions) both are manageable. Interestingly enough, the percentage of insulin
dependent diabetics and cardiac patients who choose not to maintain the recommended lifestyle
modifications and therefore are often re-hospitalized for various morbidities is relatively equal to the
percentage of addicted individuals who relapse after treatment.
But is addiction really a disease even if research shows there may be a genetic predisposition
or even brain chemistry changes? Allopathic medicine generally considers that to be a primary
disease, a syndrome must exhibit these characteristics:
 a genetic component,
 it is chronic,
 its course is progressive, and
 if left untreated it can become fatal.

In terms of addictions, as already mentioned, there is overwhelming evidence that shows there
is a genetic component. Because of the long-term nature of this syndrome and the high tendency for
relapse it is fairly obvious that, similar to diabetes and cardiac disease, addiction is chronic in its
nature. In regards to the addicted individual, this chronic component often shows up as, “I used to get
high to feel good, now getting high keeps me from feeling good.”
Addiction also displays the progressive characteristic in that the individual begins to exhibit
tolerance (manifesting as needing more of the substance to get the same high or that the same amount
yields a diminished effect). In the life of the addict, this can be seen as initially the drug use interfered
with his or her life, which then progresses to life interfering with the substance abuse.
Lastly, just like diabetes and heart disease, there is little doubt that the individual who does not
receive treatment and remains abstinent does indeed face the risk of death, either directly from an
overdose or indirectly from HIV/AIDS, hepatitis C, drunk driving, liver or cardiac disease, cancer, etc.
So given that addiction exhibits the four characteristics of a primary disease, it can now be
concluded that it is indeed a disease, a disease that is treatable albeit one that requires lifestyle changes
in order for it not to progress and become fatal. But from where does the brain part come in?
Interestingly enough, it is through the neurobiological study of addiction that much of the brain
mapping has taken place.
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While substances affect many parts of the brain, the primary area where addictions occur is the limbic
system, the seat of basic emotions and learning. Located on the medial surface of the temporal
lobe, this system is comprised of the olfactory lobe (the terminal end of the olfactory tract
making smell the only special sense that does not pass through the thalamus), the amygdala (the
nucleus that enables the H-P-A axis as well as the “fight or flight response”; also responsible for mood
and conscious emotional response to an event) and the hippocampus (critical nucleus for storing long-
term or declarative memory).
There are four primary neurotransmitters1 found in the limbic system: dopamine, serotonin (5-
hydroxytryptamine or 5-HT), GABA (4-aminobutyrate) and endorphins (endogenous opiods that bind
with receptor sites associated with blocking pain sensations and providing euphoric feelings). Each of
these neurotransmitters is removed from the synapse after stimulating the post synaptic neuron by the
pre-synaptic neuron via a process known as re-uptake in which the neurotransmitter is pumped back
into the transmitting nerve cell. This serves two purposes: 1) assures the post-synaptic neuron is fired
only once for each time the pre-synaptic neuron releases its neurotransmitter and, 2) maintains the
supply of neurotransmitter so the neuron does not have to continually produce more.
Using dopamine as an example in the following diagram, for a normal brain there is a basal
level of dopamine being release and undergoing re-uptake. Upon perceiving an event as pleasant or
pleasurable there is a smooth increase in dopamine release in the synapses. Once the stimulus ends,
there is a relatively smooth return of the dopamine level to the basal level (recovery period).

Located within the limbic system is the reward pathway (also called the pleasure pathway), the
area of the brain that initiates the basic drives for survival of the species: food, water, nurturing and
reproduction. The reward pathway begins at the ventral tegmental area (VTA), which releases

1
Neurotransmitters are chemical messengers that are released by one nerve cell (neuron) into the synapse (area between
two neurons) and received by the post-synaptic neuron. The post-synaptic neuron’s surface contains binding sites that are
specific for different neurotransmitters.
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dopamine that modulates the activity of the nucleus accumbens. The nucleus accumbens is where
pleasure is perceived (recall that pleasure reinforces an action is good for the survival of the species).
The reward pathway terminates at the prefrontal cortex, the most human part of the brain. This is
where flexible thinking and mental control take place. The prefrontal cortex is where past integrates
with the present and the future is anticipated. It is also where empathy exists.

While receptors are located throughout the brain for substances generally considered drugs of
abuse (heroin, cocaine, alcohol, tobacco, etc.), they are especially dense in the reward pathway (see
figure next page). Numerous receptor sites for endorphins are also found in this area of the brain. In
terms of the relative chances for success of remaining abstinent from a particular substance (and/or the
amount of personal effort, growth and healing required), the further along the pathway its receptors are
found, the more difficult it is to not relapse. Note in the following figure (next page) that the majority
of receptor sites for cocaine and nicotine are located nearly at the prefrontal cortex area. Research
indicates that this may be one of the reasons why remaining abstinent from these two drugs is so
difficult.
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Regardless of whether someone has a genetic predisposition to addictions or not, the

metabolites of the various potentially addictive drugs2 still have receptors in the reward pathway. So
why do some people become addicted the first time they use a particular substance while others can
use the same substance and not become hooked? The answer lies in the relative dopamine levels in
the brains of the individuals with the genetic propensity towards addictions. Neurobiological research
has shown that for the person with a predisposition for addictions, the relative basal synaptic dopamine
levels are well below those seen in the brains for individuals without the propensity to become
addicted (what was previously referred to herein as the normal brain). When pleasurable events occur
for individuals with reduced basal dopamine levels, the normal gain in dopamine release is seen; only
now the synaptic dopamine levels may only rise to the basal level of the normal brain. The

2
Behaviors such as gambling and other compulsive behaviors also stimulate the reward pathway and affect
neurotransmitter levels in a similar way. The exact mechanisms are somewhat different and are not discussed here.
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implication of this is that at a very primitive subconscious level, these individuals are not receiving
acknowledgment that their actions are good for the survival of the species. In other words, nothing
they do tells the limbic system they are doing their part to keep humans alive on this planet.
All substances that have the potential to become addictive work by increasing synaptic
dopamine levels in the pleasure pathway. In essence this reinforces the behavior by having the person
believe, again at the most primitive subconscious level, that using this substance is necessary for the
survival of the species. For those individuals with a genetic predisposition for addictions (those with
reduced basal synaptic dopamine levels), this may be the first time their brains have received this
feedback and acknowledgment. Because these are the basic drives in all humans, having someone
receive this feedback for the first time is a powerful reinforcement for that behavior. Seen in this light,
the person displaying signs of addictions in not necessarily weak willed or morally defective, but
rather, because of his or her genetic make-up, is driven to use by the same part of the brain that has
kept life alive on this planet.
What has just been described is the brain disease model of addictions and shows, at a
neurobiological level, why remaining abstinent is so difficult for many people. And while not all
individuals have the genetic predisposition component, there is a growing body of evidence that
indicates there are permanent morphologic changes in the brains of all individuals who use and abuse
certain substances (again, primarily in the reward pathway).
Different substances affect dopamine levels in different ways. The opiods (morphine, heroin
and pharmacologically derived analogs) fit into and stimulate do the same receptors as the endorphins
and acts by stimulating increased dopamine release. Cocaine in its various forms acts by blocking the
re-uptake pumps and thus the dopamine remains in the synapses much longer. This acts to continually
re-stimulate the post-synaptic neurons. This, in turn, provides increased reinforcement of the activity.
A long-term consequence of this action is that the receptor sites of the post-synaptic neurons
eventually burn out and thus no stimulation can provide a sense of pleasure or reward leading to severe
states of anhedonia.
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Addiction and Recovery
H 2 - Steps Toward Change:
Working with Ambivalence and Building Motivation for Change

Ana Oliveira and Richard Elovich

The role of counseling and group work: how do you work with an active or relapsing drug user to
support self-directed behavior change?

The crises of behavioral health issues, HIV and/or substance use in our communities demands that we
maintain a learning and open-minded posture. Counseling effectiveness in any service setting is
enhanced by using multiple approaches to match the multiple needs presented by individuals. By
drawing on aspects of harm reduction, recovery readiness and treatment approaches to create steps
toward change model, we have the opportunity to have a greater impact than if we were wedded to a
single tool.

By utilizing a steps toward change model, we can:

 Work with the individual wherever he/she may fall along the spectrum of drug use, abuse,
dependency or recovery (i.e. highly involved with drugs, marginally involved, relapsing, in
recovery, etc.);
 Avoid demanding that each individual be aware of drug involvement or be committed to
transformation or abstinence;
 Work cooperatively with the individual to set his/her own priorities and timeline for action,
rather than assume a hierarchy of issues to be dealt with;
 Operate without requiring individuals to take on any particular identity such as alcoholic, drug
or sex addict;
 Develop effective alcohol and other drug related interventions integrated into the provision of
other support, health and social services.

Working with a stage paradigm of behavior change (Prochaska, DiClement) reaches a greater number
of individuals. Rather than waiting for an individual to be motivated to change, a steps toward change
model takes a proactive role in building motivation for change. It develops a relationship with the
person, centered around building skills, awareness of inner change and connection to others engaged
in similar process. This perspective works to develop motivation out of what the individual presents
and out of an ongoing interaction between counselor and client, client and peers.

Traditional harm reduction approaches have focused largely on externally based exchanges, i.e, the
provision of materials and services. If an individual wants drug treatment or recovery they are often
refereed elsewhere. The question becomes how does an individual get interested in change and how
can that be supported by the harm reduction provider? A steps toward change approach, utilizing a
stage paradigm and motivational counseling, operates within a context where services are provided
and materials are exchanged, but it recognizes an inner process necessary to any change and fosters its
development. For individuals, inner process can mean self-awareness, ability to make choices and set
goals, assertiveness, recognition of feelings, identity and self-acceptance, etc. Working with one’s
internal reality is the foundation for any self-directed change or transformation.
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Group work. The individual process of change or transformation takes place within a social context.
Experiential learning is accomplished among peers. Group work is critical because it provides:
 A mirroring process where individuals can observe or experience similarities or contrasts in
thoughts, feeling actions;
 An opportunity to experience oneself in the presence of others, breaking the isolation, fear and
shame;
 An opportunity to witness and model a peer transformational process, i.e. efforts, attitude and
behavior changes, social relationships;
 Support for the development of alternative social networks that reinforce process of
transformation;
 Clear parameters or limits for interaction.

Utilizing a steps toward change approach with a strong emphasis on peer support and mutual help
sustains not only a particular behavior change but promotes the engagement and ongoing involvement
in the process of self-directed change and growth. Regardless of any specific behavior change, it helps
many individuals alter the nature of their relationship to the group, supporting them as they move from
initially being fearful, threatened or anxious to a point where they can carry the group within them as a
guide and companion. Individuals often find that taking the risk to share feelings, experiences and
thoughts strengthens their connection and commitment to the group. The group provides a “container”
for their individual process of growth.

Peer educators. Participation in the group automatically ascribes its members with the role of peer
educators. As the process of change unfolds individuals become aware of their ability to have an
impact on their peers. In turn, this builds self-efficacy and self-esteem, which are essential for the
maintenance and continuation of the change process. Sharing what they have experienced and what
they’ve learned becomes the mode by which they remain engaged, perceive their own growth, and
transcend their own lack of self-esteem, isolation and neediness. It gives them a role by which they
can have an impact on others.

The steps toward change model, drawing from harm reduction, recovery readiness and treatment-
based philosophies, is an expansive or organic process which encourages “clients” to become peer
counselor and educators. Unlike approaches which foster loyalty to the program or to the modality,
this process is grounded in self-directed and autonomous choices.
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Addiction and Recovery

H 3 - Information on Alcoholics Anonymous
For Anyone New Coming to A.A.
For Anyone Referring People to A.A.

This information is both for people who may have a drinking problem and for those in contact with people who
have, or are suspected of having, a problem. Most of the information is available in more detail in literature
published by A.A. World Services, Inc. This sheet tells what to expect from Alcoholics Anonymous. It
describes what A.A. is, what A.A. does, and what A.A. does not do.

What Is A.A.?
Alcoholics Anonymous is an international fellowship of men and women who have had a drinking problem. It
is nonprofessional, self-supporting, multiracial, apolitical, and available almost everywhere. There are no age or
education requirements. Membership is open to anyone who wants to do something about his or her drinking
problem.

Singleness of Purpose and Problems Other Than Alcohol

Some professionals refer to alcoholism and drug addiction as “substance abuse” or “chemical dependency.”
Nonalcoholics are, therefore, sometimes introduced to A.A. and encouraged to attend A.A. meetings. Anyone
may attend open A.A. meetings, but only those with a drinking problem may attend closed meetings.

A renowned psychiatrist, who served as a nonalcoholic trustee of the A.A. General Service Board, made the
following statement: “Singleness of purpose is essential to the effective treatment of alcoholism. The reason for
such exaggerated focus is to overcome denial. The denial associated with alcoholism is cunning, baffling, and
powerful and affects the patient, helper, and the community. Unless alcoholism is kept relentlessly in the
foreground, other issues will usurp everybody’s attention.”

What Does A.A. Do?

1. A.A. members share their experience with anyone seeking help with a drinking problem; they give person-to-
person service or "sponsorship" to the alcoholic coming to A.A. from any source.

2. The A.A. program, set forth in our Twelve Steps, offers the alcoholic a way to develop a satisfying life
without alcohol.

3. This program is discussed at A.A. group meetings.

a. Open speaker meetings — open to alcoholics and nonalcoholics. (Attendance at an open A.A. meeting is the
best way to learn what A.A. is, what it does, and what it does not do.) At speaker meetings, A.A. members “tell
their stories.” They describe their experiences with alcohol, how they came to A.A., and how their lives have
changed as a result of Alcoholics Anonymous.

b. Open discussion meetings — one member speaks briefly about his or her drinking experience, and then leads
a discussion on A.A. recovery or any drinking-related problem anyone brings up. (Closed meetings are for
A.A.s or anyone who may have a drinking problem.)

c. Closed discussion meetings — conducted just as open discussions are, but for alcoholics or prospective A.A.s
only.
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d. Step meetings (usually closed) — discussion of one of the Twelve Steps.

e. A.A. members also take meetings into correctional and treatment facilities.

f. A.A. members may be asked to conduct the informational meetings about A.A. as a part of A.S.A.P. (Alcohol
Safety Action Project) and D.W.I. (Driving While Intoxicated) programs. These meetings about A.A. are not
regular A.A. group meetings.

What A.A. Does Not Do

A.A. does not:

1. Furnish initial motivation for alcoholics to recover

2. Solicit members

3. Engage in or sponsor research

4. Keep attendance records or case histories

5. Join “councils” of social agencies

6. Follow up or try to control its members

7. Make medical or psychological diagnoses or prognoses

8. Provide drying-out or nursing services, hospitalization, drugs, or any medical or psychiatric treatment

9. Offer religious services or host/sponsor retreats.

10. Engage in education about alcohol

11. Provide housing, food, clothing, jobs, money, or any other welfare or social services

12. Provide domestic or vocational counseling

13. Accept any money for its services, or any contributions from non-A.A. sources

14. Provide letters of reference to parole boards, lawyers, court officials, social agencies, employers, etc.
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Members From Court Programs and Treatment Facilities
In recent years, A.A. groups have welcomed many new members from court programs and treatment facilities.
Some have come to A.A. voluntarily; others, under a degree of pressure. In our pamphlet “How A.A. Members
Cooperate,” the following appears:

We cannot discriminate against any prospective A.A. member, even if he or she comes to us under pressure
from a court, an employer, or any other agency.

Although the strength of our program lies in the voluntary nature of membership in A.A., many of us first
attended meetings because we were forced to, either by someone else or by inner discomfort. But continual
exposure to A.A. educated us to the true nature of the illness.... Who made the referral to A.A. is not what A.A.
is interested in. It is the problem drinker who is our concern.... We cannot predict who will recover, nor have we
the authority to decide how recovery should be sought by any other alcoholic.

Proof of Attendance at Meetings

Sometimes, courts ask for proof of attendance at A.A. meetings.
Some groups, with the consent of the prospective member, have the A.A. group secretary sign or initial a slip
that has been furnished by the court together with a self-addressed court envelope. The referred person supplies
identification and mails the slip back to the court as proof of attendance.

Other groups cooperate in different ways. There is no set procedure. The nature and extent of any group’s
involvement in this process is entirely up to the individual group.
This proof of attendance at meetings is not part of A.A.’s procedure. Each group is autonomous and has the
right to choose whether or not to sign court slips. In some areas the attendees report on themselves, at the
request of the referring agency, and thus alleviate breaking A.A. members’ anonymity.

Literature
A.A. Conference-approved literature is available in French and Spanish. For additional copies of this paper, or
for a literature catalog please write or call the General Service Office.

The A.A. Grapevine, a monthly international journal — also known as “our meeting in print” — features many
interesting stories about recovery from alcoholism written primarily by members of A.A. It is a useful
introduction and ongoing link to A.A.’s diverse fellowship and wealth of recovery experience. The Spanish-
language magazine La Viña, is published bimonthly.

For Grapevine information or to order a subscription to either the AA Grapevine or La Viña: (212) 870-3404;
fax (212) 870-3301; Web site: www.aagrapevine.org.

Conclusion
The primary purpose of A.A. is to carry its message of recovery to the alcoholic seeking help. Almost every
alcoholism treatment tries to help the alcoholic maintain sobriety. Regardless of the road we follow, we all head
for the same destination, recovery of the alcoholic person. Together, we can do what none of us could
accomplish alone. We can serve as a source of personal experience and be an ongoing support system for
recovering alcoholics.

A.A. World Services, Inc.,

Box 459, Grand Central Station,
New York, NY 10163
Tel. (212) 870-3400.
www.aa.org
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Addiction and Recovery
H 4 – The NADA Protocol and the Serenity Prayer
Shellie Goldstein LAc
Effects of Acupuncture
Acupuncture helps you to relax, focus, and get in touch with yourself and your emotions. In an
addictions / behavioral health treatment setting the NADA-style needling treatment helps you become
more attentive and participatory in groups. It is an effective drug-free group alternative.
NADA Protocol and the Serenity Prayer
The serenity prayer is a hallmark of substance abuse treatment in this country. The NADA 5 point ear
protocol complements the meaning and significance of the serenity prayer.
The NADA 5 Point Ear Acupuncture Protocol
The NADA 5 Point Ear Acupuncture Protocol is used to decrease withdrawal symptoms, shorten the
length of the withdrawal process, and prevent anxiety which may lead to potential relapse. In addition,
acupuncture improves the quality of sleep, stabilizes emotions, and helps to reestablish internal
balance.
The NADA five ear points are as follows:
Sympathetic
Shen Men
Kidney
Liver
Lung
Sympathetic (physical relaxation)
The sympathetic point when stimulated with acupuncture treatment, balances our sympathetic system.
It helps to relax the sympathetic nervous system, our fight or flight response, and allow its counterpart,
the parasympathetic system, (our ability to relax), to predominate. In essence by treating the
sympathetic point we are helping the entire body to physically relax.
Shen Men (emotional/spiritual awareness)
Shen Men, means spirit gate, and when stimulated through acudetox, it opens the door to our inner
awareness and higher power. It helps us to relax emotionally and evolve spiritually.
The Kidneys (the big picture)
The Kidney system in Chinese Medicine is the root of our energy. It gathers and stores our jing, pre
and post natal qi. Its health reflects our growth and development from birth through death. When our
kidney energy is strong, we grow and mature appropriately, and age with youthful vitality. As the
foundation of our being, the Kidneys also dominate the way that our mind and thoughts develop.
When treating the Kidney energy with acudetox we can open the door to the wisdom of our internal
awareness.
There comes a time (or many times) when age and self awareness collide. Often referred to as the
‘mid-life crisis’ it is that moment when time and destiny meet. Like an illuminated light-bulb, it is a
moment of reflection, an opportunity to review ones past achievements, and to re-evaluate future
visions. It is the realization that unfulfilled dreams have yet to come as the endless sense of time that
we once took for granted is dwindling.
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For clients in chemical dependency treatment it is that momentary flash of “Oh my God! I am ___
years old, I have been _____________ (using drugs, been in and out of prison,…) and if I continue
down this path, my life will be over before I have the chance to live it.” For some, this realization is
life changing. For others it is a fleeting moment. Ear acupuncture on the kidney point helps to hold the
door open, keep the light bulb illuminated, and help you to deal with the fear of change that comes
when realizing, reevaluating, and potentially changing your life.
The Liver (the cycles of life)
The Liver system in Oriental medicine governs the way that qi flows throughout the body. As the
army general, its job is to maintain a smooth flow of internal qi and blood. We know that the body,
mind, and spirit function optimally when in a state of balance. Life and our life’s activities can easily
throw us out of harmony. The cycles of life and the emotion of anger are both related to the Liver.
When the Liver system is imbalanced, it creates chaos within and without. Anger flares and as a result
inappropriate behavior occurs. In a drug related setting, it is often this rash and volatile behavior that
gets one in trouble both with oneself and the law. Treating the liver system helps you to stay calm and
creates internal quiescence such that one can learn to respond to life rather than react to it. When this
occurs, our behavior and decisions are more appropriate.
When faced with the perception of danger (i.e.: someone verbally or physically assaulting you) the
natural response within the addicted / behaviorally challenged population is to fight back (verbally or
physically). Whether right or wrong, the repercussions may span from injury (internal or external) to
death. In addition, it is generally the self-justification for relapse. To change ones behavior (i.e. choose
to walk away vs. fight back) requires the courage to know that in that moment you are safe, secure,
and strong enough to walk away. Acupuncture treatment on the Liver point empowers you to choose
rather than react.
The Lungs (the moment)
The Lung system governs the moment to moment taking in and letting go of oxygen, life, and our
feelings, particularly that of sadness. Most people in CD treatment have suffered personal loss either
due to drugs, alcohol, and/or lifestyle. This loss can also be related to the loss of ones’ own youth,
childhood, adolescence, and even adulthood due to the use of drugs and alcohol. The act of breathing
helps to put us in touch with our feelings. For this reason, it is often difficult for addicts and behavioral
health participants who are not used to dealing with their emotions, to breathe deeply. The Lung point
in ear acupuncture helps this population to gently accept the moment, accept their feelings, and to deal
with the sadness and grief for the losses in their lives.
Receiving the NADA protocol helps your body to heal itself. The beauty here is that it does not push
you, but rather it guides you in the direction of healing. (Empty Fire…)
The Serenity Prayer
God, (Shen Men)
grant me the serenity (Shen Men & Sympathetic)
to accept the things that I can not change (Lungs)
the courage to change the things I can (Liver)
and the wisdom to know the difference (Kidney)
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Addiction and Recovery
H5
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Addiction and Recovery
H 6 - Jellinek Chart of Alcoholism and Recovery
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Addiction and Recovery

Symptoms and Phases of Alcoholism in Women
(Jellinek Chart for Women)

Have you ever experienced: Yes

Prodromal Phase
1. Increased tolerance (need to drink more to get the same effect? 
2. Unwillingness to discuss drinking? 
3. Feelings that women who drink excessively are worse than men? 
4. Personality changes when drinking? 
5. Drinking more just before your menstrual period? 
6. Feeling more intelligent and capable when drinking? 
7. Being “supersensitive”? 
Early Stage
8. Periods of abstinence (times when you’ve tried to stop drinking)? 
9. Disapproval from others about your drinking? 
10. Rationalizing (making excuses for) drinking? 
11. Temporary losses of memory (blackouts, times you couldn’t remember what you did)
when drinking? 
12. Unexplained bruises or injuries? 
13. Drinking before facing a new situation? 
Middle Stage
14. Neglecting eating? 
15. Protecting your supply (hiding a “stash” of alcohol)? 
16. Self-pity (feeling sorry for yourself)? 
17. Feeling resentful toward others? 
18. Being permissive or lax with your children because of
guilty feelings about drinking? 
19. Drinking to feel happier but finding yourself feeling more depressed? 
20. Being told by others that you “couldn’t be an alcoholic”? 
21. “Predrinking” – drinking before a drinking occasion;
or “postdrinking” – continuing to drink after a drinking occasion? 
22. Feeling guilty about drinking? 
23. Drinking more or less continuously for a period of at least 18 hours? 
Chronic Phase
24. Starting the day with a drink? 
25. Tremors (shaky hands)? 
26. Decreased tolerance (feeling and acting drunk after just one drink)? 
27. Sneaking drinks? 
28. Gulping drinks? 
29. Persistent remorse? 
30. Devaluing personal relationships? 
31. Carrying liquor in your purse? 

Source: Adapted from James, J. E. (1975). Symptoms of alcoholism in women: A preliminary survey of AA
members. Journal of Studies on Alcohol 36(11):1564-1569, as cited in National Institution on Alcohol
Abuse and Alcoholism. (1995). Twelve-step facilitation therapy manual. (Volume 1: Project MATCH
Series). Rockville, MD: Author.
National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Section XI: Appendices 206
Reprinted with permission from Journal of Studies on Alcohol, vol. 36, pp. 1564-1569, 1975. Copyright by
Journal of Studies on Alcohol Inc., Rutgers Center of Alcohol Studies, Piscataway, NJ 08854.
National Acupuncture Detoxification Association
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Addiction and Recovery
Symptoms and Phases of Alcoholism in Men
(Jellinek Chart for Men)

Have you ever experienced: Yes

Prodromal Phase
1. Increased tolerance (need to drink more to get the same effect)? 
2. Temporary loss of memory (blackouts, times you couldn’t remember what you did)? 
3. Sneaking a drink when no one was looking? 
4. Preoccupation with drinking (thinking about drinking while working, etc.)? 
5. Hurried drinking (“chasing a high”)? 
6. Avoiding talking about your drinking because it made you uncomfortable? 
7. Loss of memory (can’t remember things you said, what you were supposed to do)? 
Crucial (basic) Phase
8. Loss of control (unable to predict how much you’ll drink)? 
9. Justifying (making excuses for drinking)? 
10. Disapproval from others about your drinking? 
11. Being extravagant with money? 
12. Aggression (verbal or physical)? 
13. Remorse (or guilt or depression about drinking)? 
14. Periods of abstinence (times when you tried to stop drinking)? 
15. Changes in your pattern of use (switching types or brands of alcohol)? 
16. Losing friends (or having fights with them) on account of your drinking? 
17. Losing a job or getting into trouble at work on account of drinking? 
18. Giving up old hobbies or activities in order to spend time drinking? 
19. Having to get treatment of some form for your drinking? 
20. Feeling resentful a lot toward others? 
21. Escape (moving or changing friends in an effort to get a “fresh start”)? 
22. Protecting your supply (hiding a stash of alcohol)? 
23. Drinking in the morning (or before work)? 
Chronic Phase
24. Drinking more or less continuously for at least 18 hours (a “binge”)? 
25. Doing things that violate your own ethical or moral standards? 
26. Inappropriate (or confused) thinking, such as hearing voices or not knowing where
you are? 
27. Decreased tolerance (feeling and acting drunk after just one drink)? 
28. Vague fears or anxiety? 
29. Tremors (shaky hands)? 
30. Feeling hopeless or suicidal? 

Source: Adapted from Jellinek, E. M. (1964). A chart of alcohol addiction and recovery. Journal of the Iowa
Medical Society. March, as cited in National Institution on Alcohol Abuse and Alcoholism. (1995).
Twelve-step facilitation therapy manual . (Volume 1: Project MATCH Series). Rockville, MD:
Author. Chart is reprinted with permission from the Journal of the Iowa Medical Society.
National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Section XI: Appendices 208
Addiction and Recovery
H 7 - Client Self-Questionnaire

Your Name: _____________________________________ Social Security No: ________________

Today’s Date: __________________ Counselor Reviewing Answers: _______________________

CAGE Questions
 Have you felt the need to Cut down on your drinking/drugging? Y N
 Are you Annoyed by people complaining about your drinking/drugging? Y N
 Do you feel Guilty about your Drinking/Drugging? Y N
 Do you ever need an Eye-opener in the morning to relieve shakes? Y N
Scoring: 2 or more yes answers suggest client has challenges with drinking/drugging

DSM-IV Based Criteria Questions for Determining Substance Dependence

 Do you find yourself having to use more of a substance to get the desired high? Y N
 Have you experienced physical or psychological withdrawal symptoms when you stopped
using a substance? Y N

 Have you taken a substance in larger amounts or for a longer time than intended? Y N

 Within the past 12 months, have you wanted to cut back but were unsuccessful? Y N
 Have you spent a great deal of time seeking, using and recovering from the effects of the
substance? Y N
 Have important social, recreational or work related activities been given up or reduced as a
result of your substance use? Y N
 Have you continued taking a substance despite knowing repeated physical or psychological
problems have been caused or made worse by its use? Y N
Scoring: 3 or more yes answers indicate a diagnosis Substance Dependence

DSM-IV Based Criteria Questions for Determining Substance Abuse

 Within the past 12 months, has your substance use resulted in your inability to fulfill
important obligations at work, school or home? Y N

 Have you repeatedly used substance(s) in situations that were physically hazardous? Y N

 Within the past 12 months have your experienced substance-related legal problems? Y N
 Have you continued using despite continuing social or interpersonal problems caused or
made worse by the effects of the substance? Y N
Scoring: one or more yes answers indicate a diagnostic impression of Substance Abuse

Client’s Signature: __________________________________________ Date: ______________

Counselor’s Signature: Date: _______________

National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Section XI: Appendices 209

Appendix I: Supplies, Vendors and Publications

I 1 - General Supplies List

The following are considered the minimum supplies necessary to begin a NADA-style acudetox
program. Quantities will be dependent upon the number of clients treated, number of days per week
treatment occurs, etc.

Supplies cabinet/cart/ portable tool box (either needs to be locking or stored in a secure area)
Comfortable chairs, preferably with head/arm support
Lined trash can
Hazardous waste containers (and state approved disposal service) or equivalent
Sharps container(s) for needle disposal – this can be done several ways:
 pint size sharps containers that can be carried to the client and placed under his or her ear
as the needles are removed (see vendor list).
 one large stationary container (use puncture-proof cups such as urine specimen containers
that the practitioners carry to the clients to collect the needles and then dump the needles
into the large container. Containers should be sanitized between sessions.)
 2 oz. – 3 oz/ plastic cups. Clients may receive individual plastic cups to “catch” stray
needles that fall out during treatment, and at a time of needle removal. Inexpensive
“bathroom” cups or the “sample” cups commonly used at grocery stores are ideal for this
purpose. The base of the cup exactly fits the ½ inch sized needle
Anti-microbial gel, hand wipes, foam or solution if there is no sink readily available.
Non-latex gloves in small, medium, large for needle removal
Alcohol pads or equivalent
Cotton balls (bulk/non-sterile) or cotton swabs
Acupuncture ear needles. ½ inch or ¼ inch, 32 – 38 gauge, sterile, disposable, stainless steel
Sleepmix tea or equivalent
Ear seeds/beads
Documentation and consent forms, client information handouts
Optional:
Plastic ear models or charts – useful for client education
Relaxation music (no vocals or percussion rhythms) and player
National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Section XI: Appendices 210

I 2 - Vendors

While the National Acupuncture Detoxification Association does not endorse any particular vendors,
the following have continually provided support to NADA’s mission and donated supplies to NADA
benefit trainings. The products below are used by many providers but are by no means the only
possible or recommended supplies.
Needles, seeds/beads, sharps containers (also tweezers, ear models):
Needles: ½ or ¼ inch, 32-38 gauge.
Helio Medical Supply
606 Charcot Avenue
San Jose, CA 95131
800-yinyang (946-9264)
www.heliomed.com
 Needles: ¼ - ½ inch, 32 – 38 gauge, for example:
o Viva Cluster Pack, 36 g (5 needles/pack): VT5-3605
o Vinco Cluster Pack 38g (5 needles/pack): NT5-3805 (100 packs/box)
o Vinco Cluster Pack 36g (5 needles/pack): NT5-3605 (100 packs/box)
 Ear Seeds: Helio Ear Seeds (100/box): ES-01/Ear Beads: gold ES-02
 One Pint Needle Disposal Container: GS-215
Lhasa OMS
230 Libbey Parkway
Weymouth, MA 02189
800-722-8775
www.lhasaOMS.com
ACP Medical Supplies, Inc.
118 Baywood Avenue
Longwood, FL 32750
877-248-4539
www.acpmedical.com
 Needles: ¼ - ½ inch, 32 – 38 gauge, for example:
o Carbo Cluster Pack 36g (5 needles/pack): CT5-3605 (100 packs/box)
 Ear Seeds: Carbo Ear Seeds (100/box): ES-01
Ear Beads/Auricular Pellets: gold-plated and magnetic
Health Point Products, Inc.
1804 Plaza Avenue, Suite 21
New Hyde Park, NY 11040
888-684-5575 - Fax 516-328-6926
www.1hpi.com
 Chinese auricular acupoints plasters (100/pack): Magnet pellet 100
National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Section XI: Appendices 211

Insurance
American Acupuncture Council
185 East First Street
Suite 1160
Santa Ana, CA 92705
800-838-0383
www.acupuncturecouncil.com
HPSO
159 E. County Line Rd.
Hatboro, PA 19040
800-982-9491
www.hpso.com

Herbal Sleepmix Tea

Nutracontrol
Box 1199 Old Chelsea Station
New York, NY 10011
212-929-3780
www.nutracontrol.com
National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Section XI: Appendices 212
Publications
Literature, reprints, general information
NADA Literature Clearinghouse
PO Box 1066
Laramie, WY 82073
888-765-NADA (6232)
www.acudetox.com
Current NADA Clearinghouse offerings (available for purchase either by contacting the NADA office
and purchasing over the phone, ordering online, or mailing a literature order form):

LITERATURE PUBLISHED BY NADA

The Writings of Michael O. Smith, MD, D, Ac
 Acupuncture for Addiction Treatment - $16.50

The basic, persuasive case. A proven tool for introducing the subject to new audiences,
especially officials, funders and other decision-makers who can help or hinder your projects.
This concise review of research and practice in booklet form is printed on heavy coated paper
with a four-color die-cut cover.

 Acupuncture for Treatment of Cocaine Addiction - $16.50

Aiming at an audience of addiction professionals looking for answers, Dr. Smith goes into detail
on how acupuncture detoxification principles evolved in the real world of the cocaine epidemic.
On heavy coated paper with a four-color die-cut cover, this booklet is a basic item for your
professional library.

 The Nature of Qi - $16.50

Why research often misses the healing effect. Analyzes why current Western research
concepts give faulty guidance to the scientific study of Qi-flow therapies, while introducing
clinicians to the patient's own healing powers. Printed in same high impact format as TRM 1
and TRM 2

Get All Three Dr. Michael O. Smith Essays - $39.99

LESSONS FROM THE FIELD

Some Lesson Learned Volume I : $16.50
How to deal with: needle fear, supervision issues, staff resistance, program management operating from a lack
of awareness and many other crucial issues.
By Claudia Voyles, L Ac

OTHER LITERATURE AND TOOLS

 Points to Change DVD - $18.00
An excellent 27-minute video giving an overview of acudetox. Excellent as a training and
outreach tool or for patient education.
National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Section XI: Appendices 213
 NADA Rising 2-DVD set - $39.99
A compilation of 6 historical videos documenting the early days of the National Acupuncture
Detoxification Association, including Miami Drug Court, Lincoln Maternal Program, and Project
Recovery.

 NADA Points Ear Chart - $12.00

An 11”x 14” wall or easel chart useful for training ADS and educating patients. Printed on
heavy stock and laminated.

The NADA Papers – these can be purchased as printed items, PDFs for half-price,
or members can download them from the NADA website for free from the Member
Center page.
 Acupuncture Detoxification Basics - $16.50
A compact summary of the core concepts.

Acupuncture Treatment for Alcoholism -- A comprehensive statement of the NADA principles

of treatment
Acupuncture Treatment of Chemical Dependency and Violence -- Practical clinical
observations
Auricular Acupuncture Treatment for Chemical Dependency -- Review of pioneer research
literature
Acupuncture: New Perspectives in Chemical Dependency Treatment – How integration
began.

 Research and Outcome Studies - $29.99

Summarizes key research findings and gives tools for planning research of your own.

Ear Acupuncture Protocol Meets Global Needs – Statement on the prevalence of acu detox
and its benefits across the clinical spectrum
Lincoln Hospital Acupuncture Drug Abuse Pgm.-- Testimony to US House of Rep.
Testimony to Office of Alternative Medicine of NIH re: Efficacy of Acupuncture in Varied Sites .
WHO'S Study -- Outcome evaluation of acupuncture impact on patients of a residential
treatment program in Australia
Portland Links Acupuncture with Housing for Good Outcomes: Incl Lit Review thru 1999.
Value of Acup. Detox. Progs. in a Sub. Abuse Trtmt. System -- The "Boston Study"

 Launching and Running a Program - $29.99

What you need to get started (or decide if you want to).

Ethics of Acupuncture Detoxification Specialists -- Foundation document for ADS practitioners

Acupuncture: The Value of the Non-Verbal – statement on the clinical efficacy of non-verbal
treatment
The Kent-Sussex Program: A Case for ADSes -- A concrete case study.
The Integration of Acupuncture into Existing Chemical Dependency Treatment Programs --
Covers varied sites
Long-Term Program Sustainability -- Alex Brumbaugh on keeping the acupuncture
detoxification component fresh
Creating an Acupuncture Treatment Program for Addiction -- A step by step approach to
National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Section XI: Appendices 214
getting it done
So You Want to Start an Acupuncture Detoxification Program? -- The famous recounting of
hard-earned experience
What is Acupuncture? -- Lincoln Hospital Patient Education Handout
Acupuncture Helps Programs More Than Patients -- Comments on the pathology of the
system
Informed Consent for Acupuncture--(English and Spanish)

 Criminal Justice and Drug Courts - $16.50

Acupuncture detoxification helps justice sanctions combine with treatment to result in court-
and jail-based recovery.

Some Principles of Therapeutic Jurisprudence – Description of relationship between client and

the drug court system and its benefits.
Use of Acupuncture in the Criminal Justice System -- Basic statement of the proper role of the
treatment provider
The Advantages of the Drug Court Treatment System -- How it can obtain better results than
orthodox treatment
Acupuncture: An Important Tool for Treating Drug Dependent Offenders -- Article from
probation/parole viewpoint
Drug court outcome: US Govt. study on acupuncture-based program.

 Mental Disorders - $16.50

Explores new possibilities for acupuncture treatment of depression, psychosis, ADHD and the
co-occuring disorder patient.

Mental Health Treatment Outcome Report from Biscailuz Jail, Los Angeles -- Documents dual
diagnosis impact
New Applications for Acupuncture Detoxification: A round up of data on its use for PTSD,
violence, ADD, impulse control
Psychiatric Functions of Acupuncture -- Deals with anxiety, psychotropics, schizophrenia,
depression, stress, hysteria
Acupuncture as Treatment for the Borderline Personality Disorder
Ear Acupuncture for Persons with Serious Mental Illness and Substance Use Disorder --
Outcomes of Texas program.

Books on Acudetox in Recovery Available for Sale on www.acudetox.com

Brumbaugh, A (1993). Transformation and Recovery: A Guide for the Design and Development of
Acupuncture-Based Chemical Dependency Treatment Programs. Still Point Press.

Brumbaugh, A (2012). The Praxis of Recovery: A New Vision for Success in Addiction Treatment.
Recovery Learning Services.

Websites
www.drugabuse.gov
www.jointogether.org
www.samhsa.gov
National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Section XI: References 215

Appendix J:
Acudetox References

Abdel-Mawgoud, M., Fateem, L., & Al-sharif, A. I. (1995). Development of a comprehensive

treatment program for chemical dependency at Al Amal hospital, Dammam. Journal of
Substance Abuse Treatment, 12(5), 369-376.

Ackerman, R.W. (1995). Acupuncture as treatment for substance abuse and its application during
pregnancy. Laramie, WY: NADA Literature Clearinghouse.

Ackerman RW (1995). Auricular acupuncture treatment for chemical dependency: a review of

the literature. Laramie, WY: NADA Literature Clearinghouse.

Ackerman RW (1993, rev. 1998). Elements of U.S. Drug Policy.

Acupuncture (1997). NIH Consensus Statement, Nov. 3-5; 15(5): 1-34.

Ahlberg R, Skarberg K, Brus O, Kjellin L. Auricular acupuncture for substance use: a

randomized controlled trial of effects on anxiety, sleep, drug use and use of addiction
treatment services. Subst Abuse Treat Prev Policy 2016; 11: 24.

Anonymous (2000). Acupuncture keeps addicts on treatment programmes. Nursing Standard,

15(3). 10.

Avants, K. S., Margolin, A., Chang, P., Kosten, T. R., & Birch, S. (1995). Acupuncture for the
treatment of cocaine addiction: Investigation of a needle puncture control. Journal of
Substance Abuse Treatment, 12(3), 195-205.

Avants. S. K., Margolin, A., Holford, T. R., & Kosten, T. R. (2000). A randomized controlled
trial of auricular acupuncture for cocaine dependence. Archives of Internal Medicine,
160, 2305-2312.

Bainbridge, M., Derrickson, C., Leberg, M., Seaber, Valentine, L., & Bainbridge, J. (1996). The
effect of the use of electro-acupuncture (EA) versus standard acupuncture (SA) of
completion of the program in the detoxification of opiate-dependent adults at Hooper
detox center.

Baker TE, Chang G. The use of auricular acupuncture in opioid use disorder: a systematic
literature review. American Journal on Addictions 2016; 25: 592-602.

Baum AS, Burnes DW (1993). A Nation in Denial: The Truth About Homelessness. San
Francisco, Boulder, Oxford: Westview Press.

Bennett, C. (1995). The tao, acupuncture, and crack cocaine. Capsules & Comments in
Psychiatric Nursing, 1(4), 2-8.
National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Section XI: References 216

Bergdahl, L., Berman, A. H., &Haglund, K. (2014). Patients’ experience of auricular

acupuncture during protracted withdrawal. Journal of Psychiatric and Mental Health
Nursing, 21:163-169.

Bergdahl L, Broman JE, Berman AH, Haglund K, von Knorring L, Markstrom A. Auricular
acupuncture and cognitive behavioral therapy for insomnia: a randomized controlled trial.
Sleep Disorders, 2016; 7057282.

Berle, C. A. (July, 1997). Report on the use of acupuncture for substance dependencies within
the Australian setting. Presented at The Third Australasian Acupuncture and Chinese
Herbal Medicine Conference.

Berman, A. H. (2002). Auricular acupuncture in prison psychiatric units: A pilot study. Acta
Psychiatr Scand, 106, 152-157.

Berman, A. H. (2004). Enhancing health among drug users in prison. Health Equity Studies, 3,
80-85.

Berman, A. H., Lundberg, U., Krook, A. L., & Gyllenhammer, C. (2004). Treating drug using
prison inmates with auricular acupuncture: A randomized controlled trial. Journal of
Substance Abuse Treatment, 26, 95-102.

Bier, I. D., Wilson, J., Studt, P., & Shakleton, M. (2002). Auricular acupuncture, education, and
smoking cessation: A randomized, sham-controlled trial. American Journal of Public
Health, 92(1), 1642-1647.

Blow, D. (1994). The acupuncture treatment of alcohol and chemical dependency. The Journal
of Chinese Medicine, 45, 5-8.

Blow, D., Gyllenhammer, C., & Stevens, A. (1995). Pilot project report: Research and
information on the use of auricular acupuncture in the criminal justice system in Sweden,
the United Kingdom, and Italy. Cranstoun Projects Prisoners Resource Service for the
Eurpoean Network of Services for Drug Users in Prison, 1-33.

Boucher, T. A., Kiresuk, T. J., & Trachtenberg, A. I. (1998). Alternative therapies. In A. W.

Graham & T. K. Schultz (Eds.), Principals of Addiction Medicine, 2nd ed. (pp. 371-394).
Chevey Chase, MD: ASAM.

Brewington, V., Smith, M., Lipton, D. (1994). Acupuncture as a detoxification treatment: An

analysis of controlled research. Journal of Substance Abuse Treatment, 11(4), 289-307.

Bruce, L. (2011). Ear acupuncture: A tool for recovery. Yale School of Medicine Department of
Psychiatry Website. Contributed by Connecticut Mental Health Center. Retrieved from
http://medicine.yale.edu/psychiatry/newsandevents/cmhcacupuncture.aspx

Brumbaugh A (1993). Transformation and Recover: A Guide for the Design and Development of
National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Section XI: References 217

Acupuncture-Based Chemical Dependency Treatment Programs. Santa Barbara, CA: Still

Point Press.

Buell, P. D. (1998). Chinese medicine on the “gold mountain”. In Disease and Medical Care in
the Mountain West, pp. 95-109. Nevada: University of Nevada Press

Bullock, M. L., Umen, A. J., Culliton, P. D., & Olander, R. T. (1987). Acupuncture treatment of
alcoholic recidivism: A pilot study. Alcoholism: Clinical and Experimental Research,
11(3), 292-295.

Bullock, M. L., Kiresuk, T. J., Pheley, A. M., Culliton, P. D., & Lenz, S. K. (1999). Auricular
acupuncture in the treatment of cocaine abuse: A study of efficacy and dosing. Journal of
Substance Abuse Treatment, 16(1), 31-38.

Bullock, M. L., Culliton, P. D., & Olander, R. T. (1989). Controlled trial of acupuncture for
severe recidivist alcoholism. The Lancet, 1435-1439.

Carr DJ. (2015) The safety of obstetric acupuncture forbidden points revisited. Acupunt Med,
doi:10.1136/acupmed-2015-010936

Carter, K. O., Olshan-Perlmutter, M., Norton, H. J., & Smith, M. O. (2011). NADA acupuncture
prospective trial in patients with substance use disorders and seven common health
symptoms. Medical Acpuncture, 23(3), 131-135.

Carter K & Olshan-Perlmutter M.(2014) NADA Protocol. J Addictions Nursing, 25:182-187.

Carter, K. O. and Olshan-Perlmutter, M. (2015) Impulsivity and Stillness: NADA,

Pharmaceuticals, and Psychotherapy in substance use and other DSM 5 disorders. Behav.
Sci, 5, 537-546.

Center for Substance Abuse Treatment (2006). Detoxification and Substance Abuse Treatment.
Treatment Improvement Protocol (TIP) Series 45. DHHS Publication No. (SMA) 06-
4131.

Chen, A., Wu, C. W., Ho, S. P., Blum, K., & Chen, T. (2007). Neurochemical and clinical
aspects of acupuncture & auriculotherapy: Adaptation in United States for substance use
disorder (SUD), a clinical subtype of reward deficiency syndrome (RDS). Journal of
Occupational Safety and Health, 15, 308-332.

Cho SH, Wang WW. Acupuncture for alcohol dependence: a systematic review. (2009) Alcohol
Clin Exp Res. 33:1305-1313.

Clavel-Chapelon F, Paoletti C, Banhamou S (1997). Smoking cessation rate 4 years after

treatment by nicotine gum and acupuncture. Preventative Medicine, 26(1): 25-28.
National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Section XI: References 218

Cole, B., & Yarberry, M. (2011). NADA training provides PTSD relief in Haiti. Deutsche
Zeitschrift für Akupunktur, 54, 21-24.

Cowan, D. (2011). Methodological issues in evaluating auricular acupuncture therapy for

problems arising from the use of drugs and alcohol. Acupuncture Medicine, 29(3), 227-
229.

Cui, C. L., Wu, L. Z., & Luo, F. (2008). Acupuncture for the treatment of drug addiction.
Neurochemical Research, 33, 2013-2022.

Cullington, P. D., & Kiresuk, T. J. (1996). Overview of substance abuse acupuncture treatment
research. The Journal of Alternative and Complementary Medicine, 2(1), 149-159.

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. The Journal of Alternative and Complementary
Medicine, 10(6), 985-1000.

Dale, R. A. (1993). Addictions and acupuncture: The treatment methods, formulae, effectivenss
and limitations. American Journal of Acupuncture, 21(3), 247-266.

De Lorent L, Agorastos A, Yassouridis A, Kellner M, Muhtz C. Auricular acupuncture versus

progressive muscle relaxation in patieants with anxiety disorders or major depressive
disorder: a prospective parallel group clinical trial. Journal Acupuncture Meridian
Studies, 2016; 9: 191–199.

Felitti, VJ, Anda, RF, Nordenberg, D, Williamson, DF, Spitz, AM, Edwards, V, Koss, MP, et
Al. (1998) The relationship of adult health status to childhood abuse and household
dysfunction. American Journal of Preventive Medicine. 14:245-258.

Felitti VJ. (2002) Belastungen in der Kindheit und Gesundheit im Erwachsenenalter: die
Verwandlung von Gold in Blei. Z psychsom Med Psychother, 48(4): 359-369.

Finigan M (1998). An outcome program evaluation of the Multnomah County S.T.O.P. Drug
Diversion Program. Prepared for Multnomah County Department of Community
Corrections.

Flanagan, L. W. (1995). Meeting the special needs of females in custody: Maryland’s unique
approach. Federal Probation, 59(2), 49-53.

Gates, S., Smith, L. A., & Foxcroft, D. (2006). Auricular acupuncture for cocaine dependence.
Cochrane Database of Systematic Reviews, 1, 1-18.

Gossop, M., & Bradley, B. (1984). Insomnia among addicts during supervised withdrawal from
opiates: A comparison of oral methadone and electrostimulation. Drug and Alcohol
Dependence, 13, 191-198.
National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Section XI: References 219

Gurevich, M. I., Duckworth, D., Imhof, J. E., & Katz, J. L. (1996). Is auricular acupuncture
beneficial in the inpatient treatment of substance-abusing patients?: A pilot study.
Journal of Substance Abuse Treatment, 13(2), 165-171.

Gyllenhammer, C. (?). Ear acupuncture at Sweden’s färigsö prison. Study for The Department of
Toxicomania, for The Stockholm Regional Office of the Swedish National Prison and
Probation Administration.

Han, J.S., & Zhang, R. L. (1993). Suppression of morphine abstinence syndrome by body
electroacupuncture of different frequencies in rats. Drug and Alcohol Dependence, 31,
169-175.
Hancock E (1999). Bare bones acupuncture, big time recovery. Meridians. 6(2): 17-24.

Harding, C., Harris, A., & Chadwich, D. (2008). Auricular acupuncture: A novel treatment for
vasomotor symptoms associated with luteinizing-hormone releasing hormone agonist
treatment for prostate cancer. BJU International, 103, 186-190.

Hase, M & Hase, A. (2014) Implementation of the NADA protocol in psychosomatic medicine.
Akupunktur, 57, 12-15.

He, D., Berg, J. E., & Hostmark, A. T. (1997). Effects of acupuncture on smoking cessation or
reduction for motivated smokers. Preventive Medicine, 26, 208-214.

He D, Medbø JI, Høstmark AT (2001). Effect of acupuncture on Smoking Cessation or

Reduction: An 8-month and 5-year follow-up study. Preventative Medicine, 33: 364-372

Hollifield, M., Sinclair-Lian, N., Warner, T. D., & Hammerschlag, R. (2007). Acupuncture for
posttraumatic stress disorder: A randomized controlled pilot trial. The Journal of Nervous
and Mental Disease, 195(6), 504-513.

Janssen, P. A., Demores, L. C., Kelly, A., Thiessen, P., & Abrahams, R. (2012). Auricular
acupuncture for chemically dependent pregnant women: A randomized controlled trial of
the NADA protocol. Substance Abuse Treatment, Prevention, and Policy, 7(48), 1-10.

Kailasam VK, Anand P, Melyan Z. Establishing an animal model for National Acupuncture
Detoxification Association (NADA) auricular acupuncture protocol. Neurosci Lett 2016;
624: 29–33.

Karst M, Passie T, Friedrich S, Wiese B, & Schneider U. (2002) Acupuncture in the treatment of
alcohol withdrawal symptoms: a randomized placebo –controlled inpatient study.
Addiction Biology, 7, 415-419.q1

Killeen TK, Haight B, et al (2002). The effects of auricular acupuncture on psychophysiological

measures of cocaine craving. Issues in Mental Health Nursing, 23: 445 – 459.
National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Section XI: References 220

Kim, Y. H., Schiff, E., Waalen, J., & Hovell, M. (2005). Efficacy of acupuncture for treating
cocaine addiction: A review paper. Journal of Addictive Diseases, 24(4), 115-132.

Kim MR, Kim SJ, Lyu YS, Kim SH, Lee YK, Kim TH, Shim I, Zhao R, Golden GT, and Yang
CH (2005). Effect of acupuncture on behavioral hyperactivity and dopamine release in
the nucleus accumbens in rats sensitized to morphine. Neurosci Letters.

Konefal, J., Duncan, R., & Clemence, C. (1994). The impact of the addition of an acupuncture
treatment program to an existing metro-dad county outpatient substance abuse treatment
facility. Journal of Addictive Diseases, 13(3), 71-99.

Kuo SY, Tsai SH, Chen SL, Tzeng YL. Auricular acupressure relieves anxiety and fatigue, and
reduces cortisol levels in post-cesarean section women: a single-blind, randomized
controlled study. Int J Nurs Stud, 2016; 53: 17–26.

Kurath-Koller S, Bauchinger S, Sperl D, et al. (2014) Use of NADA ear acupuncture in an

adolescent with phantom limb pain after surgery for osteosarcoma. Acupunct Med, O: 1-
3.

Kutchins S (1991). The treatment of smoking and nicotine addiction with acupuncture. In
Cocores, I. A. (Ed.) The Clinical Management of Nicotine Dependence. New York:
Springer Verlag.

LaPaglia D, Bryant K, Serafini K. Implementation of the National Acupuncture Detoxification

Association protocol in a community mental health setting. J Alternative and
Complementary Medicine, 2016; 22: 729-731.

Lau, M.P. (1976). Acupuncture and addiction: An overview. Addictive Diseases: An

International Journal, 2(3), 449-463.

Lee, M. S., Shin, B. C., Suen, L. K., Park, T. Y., & Ernst, E. (2008). Auricular acupuncture for
insomnia: A systematic review. International Journal of Clinical Practice, 62(11), 1744-
1752.

Li M, Chen K, Mo Z (2002). Use of qigong therapy in the detoxification of heroin addicts.

Alternative Therapies, 8(1): 50-58.

Lin JG, Chan YY, & Chen YH, (2012) Acupuncture for the treatment of opiate addiction,
Evidence-based complementary and Alternative Medicine doi:10.1155/2012/739045

Lipton, D. S., Brewington, V., & Smith, M. (1994). Acupuncture for crack-cocaine
detoxification: Experimental evaluation of efficacy. Journal of Substance Abuse
Treatment, 11(3), 205-215.
National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Section XI: References 221

Margolin, A., Avants, K., Chang, P., & Kosten, T. R. (1993). Acupuncture for the treatment of
cocaine dependence in methadone-maintained patients. American Academy of
Psychiatrists in Alcoholism and Addictions, 2(3), 194-201.

Margolin, A., Chang, P., Avants, S. K., & Kosten, T. R. (1993). Effects of sham and real
auricular needling: Implications for trials of acupuncture for cocaine addiction. American
Journal of Chinese Medicine, 21(2), 103-111.

Margolin, A., Avants, S. K., Chang, P., Birch, S., & Kosten, T. R. (1995). A single-blind
investigation of four auricular needle puncture configurations. American Journal of
Chinese Medicine, 23(2), 105-114.

Margolin, A., Avants, S. K., & Kleber, H. D. (1998). Rationale and design of the cocaine
alternative treatments study (CATS): A randomized, controlled trial of acupuncture. The
Journal of Alternative and Complementary Medicine, 4(4), 405-418.

Margolin, A., & Kleber, H. D. (1998). Investigating alternative medicine therapies in

randomized controlled trials. Journal of the American Medical Association, 280(18),
1626-1628.

Margolin, A., Kleber, H. D., Avants. S. K., Konefal, J., Gawin, F., Stark, E., Sorensen,
J.,…Vaughan, R. (2002). Acupuncture for the treatment of cocaine addiction. Journal of
the American Medical Association, 287(1), 55-63.

McLellan, A. T., Grossman, D. S., Blaine, J. D., & Haverkos, H. W. (1993). Acupuncture
treatment for drug abuse: A technical review. Journal of Substance Abuse Treatment, 10,
569-576.

Mitchell ER (1995). Fighting Drug Abuse with Acupuncture. Berkeley, CA: Pacific View Press.

Moner, S. E. (1996). Acupuncture and addiction treatment. Journal of Addictive Diseases, 15(3),
79-99.

National Institutes of Health Consensus Statement (1997). Acupuncture, 15(5). 1-34.

Niemtzow, R. C. (2007). Battlefield acupuncture. Medical Acupuncture, 19(4), 225-228.

Nixon, M. K., Cheng, M., & Cloutier, P. (2003). An open trial of auricular acupuncture for the
treatment of repetitive self-injury in depressed adolescents. The Canadian Child and
Adolescent Psychiatry Review, 12, 10-12.

Newmeyer, J. A., Johnson, G., Klot, S. (1984). Acupuncture as a detoxification modality.

Journal of Psychoactive Drugs, 16(3), 241-261.

Ng, L. K. Y. & Wen, H. L. (1981). Acupuncture in substance abuse. In J. H. Lowinson (Ed.),

Substance Abuse: Clinical Problems and Perspectives (pp. 509-516). Baltimore:
Williams & Wilkins.
National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Section XI: References 222

Office of Applied Studies (2002). National Survey of Substance Abuse Treatment Services (N-
SSATS): 2000. Data on Substance Abuse Treatment Facilities. DASIS Series: S-16.
DHHS Publication No. (SMA) 02-3668. Rockville, MD.

Oleson TD (2002). Commentary on auricular acupuncture for cocaine abuse. The Journal of
Alternative and Complementary Therapies, 8(2): 123 – 125.

Olsen A (1998). The needle and the inmates – Renewed. Meridians, 5(4):13-16.

Omura Y, Smith M, Wong F, et al (1975). Electro-acupuncture for drug addiction withdrawal.

Acupuncture and Electro-Therapeutics Research International Journal, 1: 231-233.

Otto, K. C., Quinn, C., & Sung, Y.F. (1998). Auricular acupuncture as an adjunctive treatment
for cocaine addiction. American Academy of Addiction Psychiatry, 7(2), 164-170.

Oyola-Santiago T, Knofp R, Robin T, Harvey K. (2013) Provision of auricular acupuncture and

acupressure in a university setting. J American College Health, 61:432-434.

Patterson, M. A., Patterson, L., Flood, N. V., Winston, J. R., & Patterson, S. I. (1993).
Electrostimulation in drug and alcohol detoxification: Significance of stimulation criteria
in clinical success. Addiction Research, 1, 130-144.

Peckham, R. (2005). The role and impact of the NADA protocol (daily group acupuncture
treatment used in addiction): Explanatory case studies. (Dissertation) University of
Westminster.

Power AE. (2004) Sleep and memory Consolidation. PNAS, 101:1795-1796.

Raith W, Schmolzer GM, Resch B, Reiterer F, Avian A, Kostenberger M, & Urlesberger B,

(2015) Laser acupuncture for neonatal abstinence syndrome: a randomized controlled
trial. Pediatrics 136, DOI: 10.1542/peds.2015-0676

Reilly PM, Buchanan TM, Vafides C, Breakey S, Dykes P. (2014) Auricular acupuncture to
relieve health care workers’ stress and anxiety. Dimensions of Critical Care Nursing, 33,
DOI: 10.1097/DCC.0000000000000039

Ruchames, P., Knell, T., & Simmons-Ford, E. (?). Acupuncture for the drug addicted federal
offender: A pilot study.

Russell, L. C., Sharp, B., & Gilbertson, B. (2000). Acupuncture for addicted patients with
chronic histories of arrest: A pilot study of the consortium treatment center. Journal of
Substance Abuse Treatment, 19, 199-205.

Santasiero, R. P., & Neussle, G. (2005). Cost-effectiveness of auricular acupuncture for treating
substance abuse in an HMO setting: A pilot study. Medical Acupuncture, 16(3), 39-42.
National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Section XI: References 223

Sapir-Weise R, Berglund M, Frank A, Kristenson H (1999). Acupuncture in alcoholism

treatment: A randomized outpatient study. Alcohol & Alcoholism, 34(4), 629 – 635.

Sato, T., Takeshige, C., & Shimizu, S. (1991). Morphine analgesia mediated by activation of the
acupuncture-analgesia-producing system. Acupuncture & Electro-TherapeuticsResearch
International Journal, 16, 13-26.

Seymour RB, Smith DE (1987). Drugfree: A Unique, Positive Approach to Staying Off Alcohol
and Other Drugs. New York: Facts on File Publications.

Shwartz, M., Saitz, R., Mulvey, K., & Brannigan, P. (1998). The value of acupuncture
detoxification programs in a substance abuse treatment system. Journal of Substance
Abuse Treatment, 17(4), 305-312.

Sinclair-Lian, N., Hollifield, M., Menahce, M., Warner, T., Viscaya, J., & Hammerschlag, R.
(2006). Developing a traditional Chinese medicine diagnostic structure for post-traumatic
stress disorder. The Journal of Alternative and Complementary Medicine, 12(1), 45-57.

Smith M. (1979) Acupuncture and natural healing in drug detoxification. Am J Acupunct. 7:97-
107.

Smith, M. O., Squires, R., Aponte, J., Rabinowitz, N., & Bonilla-Rodriguez, R. (1982).
Acupuncture treatment of drug & alcohol abuse: 8 years experience emphasizing
tonification rather than sedation. American Journal of Acupuncture, 9-10.

Smith MO (1993). Testimony presented to NIH Office of Alternative Medicine, May 21.
Laramie, WY: NADA Literature Clearinghouse.

Smith MO (1993). Acupuncture helps programs more than patients. Presentation at NADA
conference. Laramie, WY: NADA Literature Clearinghouse.

Smith MO Brewington V, and Culliton P (1998) Acupuncture in addiction treatment. In

Sherman, B. R., Sanders, L.M., Trinh, C. (Eds.) Addiction and Pregnancy: Empowering
Recovery Through Peer Counseling. Praeger Publishing.

Smith MO, Brewington V, Culliton PD, et al (Eds.) Substance Abuse: A Comprehensive

Textbook. Baltimore: Williams and Wilkins.

Smith MO, and Khan I (1989). Acupuncture program for treatment of drug addicted persons.
Bulletin on Narcotics. XL (1).

Smith MO, McKenna B (1994). The integration of acupuncture into existing chemical
dependency treatment programs. Paper presented to the 21st International Institute on
Prevention and Treatment of Drug Dependence, Prague, Czech Republic.
National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Section XI: References 224

Smith, M. O. (2009). Ear acupuncture protocol meets global needs. Medical Acupuncture, 21(2),
75

Stuyt, E.B. (2005). Benefits of Auricular Acupuncture in Tobacco-free Inpatient Dual-Diagnosis

Treatment. Journal of Addictive Disease, 24: 125.

Stuyt, E. B., Meeker, J. L. (2006). Benefits of auricular acupuncture in tobacco-free inpatient

dual-diagnosis treatment. Journal of Dual Diagnosis, 2(4), 41-52.

Stuyt, EB (2014) Ear acupuncture for co-occurring substance abuse and borderline personality
disorder: an aid to encourage treatment retention and tobacco cessation. Acupunct Med,
32:318-324.

Stuyt, EB (2014) Enforced abstinence from tobacco during in-patient dual-diagnosis treatment
improves substance abuse treatment outcomes in smokers. Am J Addictions

Stuyt EB, Voyles CA. The National Acupuncture Detoxification Association protocol, auricular
acupuncture to support patients with substance abuse and behavioral health disorders:
current perspectives. Substance Abuse and Rehabilitation, 2016; 7: 169-180.

Taylor-Young P, Miller D, Ganzini L, Golden S, & Hansen L. (2014) Feasibility and

acceptability of group acupuncture in veterans with hepatitis C: a pilot study. Medical
Acupuncture, 26: 208-214.

Ter Riet G, Kleijnen J, Knipshild P. (1990) A meta-analysis of studies into the effect of
acupuncture on addiction. Br J Gen Pract. 40:379-382.

Tian X, Krishnan S. (2006). Efficacy of auricular acupressure as an adjuvant therapy in

substance abuse treatment: A pilot study. Alternative Therapies, 12(1), 66-69.

Timofeev, M. F. (1996). Influence of acupuncture and pharmacotherapy in sensitivity of sensory

systems to alcohol irritants in patients with alcoholism. American Journal of Chinese
Medicine, 24(2), 177-184.

Toteva, S., & Milanov, I. (1996). The use of body acupuncture for treatment of alcohol
dependence and withdrawal syndrome: A controlled study. American Journal of
Acupuncture, 23(1), 19-25.

Trachtenberg AI (2000). Testimony to the White House Commission on Complementary and

Alternative Medicine Policy, December 18, 2000. Rockville, MD. Substance Abuse and
Mental Health Services Administration.

Trumpler F, Oez S, et al (2003). Acupuncture for alcohol withdrawal: a randomized controlled

trail. Alcohol & Alcoholism, 38(4): 369 – 375.
National Acupuncture Detoxification Association
Training Resource Manual © NADA 2017 Section XI: References 225

Vickers, A. J., Rees, R. W., Zollman, C. E., McCarney, R., Smith, C. M., Ellis, N., Fisher, P., &
Van Haselen, R. (2004). Acupuncture for chronic headache in primary care: Large,
pragmatic, randomized trial. BMJ, 1-6.

Wang, Z. (2001). Acupuncture combined with medicine for treatment of heroin dependence.
American Journal of Traditional Chinese Medicine, 2(1), 13-14.

Washburn, A. M., Fullilove, R. E., Fullilove, M. T., Keenan, P. A., McGee, B., Morris, K. A.,
Sorensen, J. L. & Clark, W. W. (1993). Acupuncture heroin detoxification: A single-
blind clinical trial. Journal of Substance Abuse Treatment, 10, 345-351.

Wells, E. A., Jackson, R., Diaz, O. R., Stanton, V., Saxon, A. J., & Krupski, A. (1994).
Acupuncture as an adjunct to methadone treatment services. The American Academy of
Psychiatrists in Alcoholism & Addictions, 4(3), 198-214.

Wen HL. Cheng SYC (1973). Treatment of drug addiction by acupuncture and electrical
stimulation. Asian Journal of Medicine, 9, 138-141.

White A. (2013) Trials of acupuncture for drug dependence: a recommendation for hypotheses
based on the literature. Acupunct Med. 31:297-304.

White AR, Rampes H (1997). Acupuncture in smoking cessation. In: Cochrane Database
Systemic Reviews. Oxford.

White AR, Resch KL, Ernst E (1999). A meta-analysis of acupuncture techniques for smoking
cessation. Tobacco Control, 8, 393 – 397.

Wonderling, D., Vickers, A. J., Grieve, R., & McCarney, R. (2004). Cost effectiveness analysis
of a randomized trial of acupuncture for chronic headache in primary care. BMJ, 1-5.

Yang CY, Kwon YK, et al (2004). Acupuncture attenuates repeated nicotine-induced

behavioral sensitization and c-Fos expression in nucleus acumbens and striatum of the
rat. Neuroscience Letters, 358(2): 87-90.

Yarberry, M. (2010). The use of the NADA protocol for PTSD in Kenya. German Journal of
Acupuncture & Related Techniques, 53, 6-11.

Yarberry, M. (2011). Acupuncture training at Malindi prison. Journal of Chinese Medicine, 97,
34-39.