The Integrated Approach to Treating Addiction

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The Integrated Approach to Treating Addiction

• Andrea Pennington, M.D., C.Ac.
• Andrea_at_PenningtonInstitute.com

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The Integrated Approach to Treating Addiction

• Acupuncture
• Mind-Body Therapies
• Herbal Remedies
• Somatic Psychotherapy

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ACUPUNCTURE

• Documented in Chinese literature as early as the
  Han dynasty in the second century BC, in the
  Huang Di Nei Jing
• (Yellow Emperors Classic of Medicine).

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What is acupuncture?

• Acupuncture is a therapy which was developed in
  China over 3,000 years ago
• Utilizes tiny, pre-sterilized needles to contact
  and move Qi (pronounced che)
• Our Qi, or vital life force, impacts every aspect
  of our bodies.

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Acupuncture for addiction treatment in the US

• In 1973, Wen reported that opiate-addicted
  patients who were using electroacupuncture to
  treat postsurgical pain described relief from
  symptoms of withdrawal.
• Omura brought the treatment protocol to Lincoln
  Hospital in New York in 1974
• Michael Smith, MD developed a five-point
  auricular treatment protocol for addictions that
  is currently being taught and advocated by the
  National Acupuncture Detoxification Association
  (NADA).

Wen JL, Cheung SYC Treatment of drug addiction
by acupuncture and electrical stimulation. Asian
J Med 9138141, 1973. Smith MO, Khan I An
acupuncture programme for the treatment of
drug-addicted persons. Bull Narcot 403541,
1988.
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Effects of Acupuncture onAddiction

• Decreases cravings
• Improves sleep patterns
• Reduces anxiety
• Aids in stress reduction
• Improves participation in counseling process

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How does acupuncture work?

• Through a series of non-invasive auricular (ear)
  treatments we contact and move qi to balance the
  bodys energy
• Acupuncture needles stimulate peripheral nerves
  to cause release of endorphins in the brain,
  thereby causing relaxation and a sense of
  well-being
• Acupuncture thus can provide direct biochemical
  treatment of opiate and ethanol craving and
  withdrawal.

McLellan AT, Grossman DS, Blaine JD, Haverkos HW
Acupuncture treatment for drug abuse A technical
review. J Subst Abuse Treat 10569576, 1993
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Auriculotherapy

• Ear is a microsystem of the body

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NADA Protocol

• 5 Points for Addiction
• Sympathetic
• Shen Men (Spirit Gate)
• Kidney
• Liver
• Lung
• POINT ZERO (OPTIONAL)

McLellan AT, Grossman DS, Blaine JD, Haverkos HW
Acupuncture treatment for drug abuse A technical
review. J Subst Abuse Treat 10569576, 1993
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Acupuncture Uses in Addiction

• Alcohol Cocaine Opiates Marijuana

• 1989, Bullock study auricular acupuncture
  effective in the treatment of recidivist
  alcoholics.
• 80 recidivist alcoholics enrolled in a
  treatment facility were randomized to receive
  either the appropriate treatment protocol
  (treatment group) or sham acupuncture at sites
  close to the appropriate points (control group).
• The outcomes measured completion of the
  program self-reported abstinence at 1, 3, 6
  months following treatment.
• Of 40 patients in treatment group, 21 finished
  the program, whereas only 1 of 40 in the control
  group completed treatment.
• Fewer treatment group patients than control
  group patients reported drinking episodes at 1-,
  3-, and 6-month follow-up evaluations.

Bullock ML, Culliton PD, Olander RT Controlled
trial of acupuncture for severe recidivist
alcoholism. Lancet 114351439, 1989.
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Acupuncture Uses in Addiction

• Alcohol Cocaine Opiates Marijuana

• 1998, Shwartz retrospective study
• Compared residential detoxification programs
  that used acupuncture with programs that did not.
  
• 6907 patients completed non-acupuncture
  programs and 1104 patients completed programs
  that used acupuncture as an adjunctive therapy.
• The study subjects were dependent on alcohol,
  cocaine, crack, heroin, or marijuana, or on a
  combination of these drugs.
• The primary outcome measured was readmission to
  a detoxification program in the 6 months
  following discharge.
• Those who completed programs offering
  acupuncture were readmitted to detoxification
  less frequently than were those from conventional
  programs

Shwartz M, Saitz R, Mulvey K, Brannigan P The
value of acupuncture detoxification programs in a
substance abuse treatment system. J Subs Abuse
Treat 17305312, 1998.
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Acupuncture Uses in Addiction

• Alcohol Cocaine Opiates Marijuana

• 2000, Avants, et al., randomized controlled trial
  
• Auricular acupuncture for cocaine dependence
• 82 patients randomized to receive either
  appropriate acupuncture treatment, sham
  acupuncture, or relaxation therapy.
• Thrice-weekly urine screening conducted over an
  eight-week period.
• Patients who received acupuncture protocol were
  less likely to test positive for cocaine on urine
  screening than were patients in the sham
  acupuncture control group or the relaxation
  control group.

Avants SK, Margolin A, Holford TR, Kosten TR A
randomized controlled trial of auricular
acupuncture for cocaine dependence. Arch Intern
Med 16023052312, 2000.
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Acupuncture and stress management

• Decreased sensation of distressful fight or
  flight response
• Reduced cortisol levels
• Decreased impulsivity

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Mind-Body Therapies

• Meditation
• EMDR
• Biofeedback
• Neurofeedback
• Guided Imagery
• Hypnosis
• Yoga
• Therapeutic Massage
• Somatic Psychotherapies

www.emdr.com www.ronkurtz.com/writings.html
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Mind-Body Therapies

• Eye Movement Desensitization/Reprocessing
  (EMDR) combines a range of therapeutic approaches
  with eye movements or other forms of rhythmical
  stimulation, such as hand taps or sounds.
• Some speculate that the rapid unique
  therapeutic element of EMDR the eye movements
  or other rhythmical stimulation might help the
  brain access and process traumatic material.
• EMDR has been most effective with
  single-incident trauma, but its uses continue to
  evolve in addressing longer histories of
  emotional or physical trauma, and in balancing
  other aspects of a person's life..

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Mind-Body Therapies

• Biofeedback uses sensors or electrodes
  attached to the body to measure skin temperature
  or muscle tension. The person can see or hear
  readingsfeedbackand can learn to make subtle
  changes that bring relief and improvement to a
  variety of disorders.
• Neurofeedback (EEG biofeedback) uses
  electrodes attached to the scalp which provide
  brainwave pattern information, allowing the
  person to see the effects of relaxation,
  breathing, and focused attention, and learn to
  slow down or speed up brain waves.

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Body Oriented Psychotherapy

• Because the body often holds onto the memory of
  traumatic experiences, modalities that aid in the
  release and resolution of trauma must be included
  in the treatment process

www.ronkurtz.com/writings.html www.sensorimotorpsy
chotherapy.org/psychotherapists.html www.ibponline
.com/aboutibp.html
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What is Trauma?
Medical Definition A serious or critical bodily
injury, wound, or shock.
Psychiatric Definition An experience that is
emotionally painful, distressful, or shocking,
which often results in lasting mental and
physical effects
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Varied Responses to Trauma
Are based on their level of emotional and
psychological development at the time of the
traumatic event and are expressed along the
following dimensions

• Cognitive
• Emotional
• Spiritual
• Behavioral
• Physical

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Responses to Trauma Cognitive

• Trouble concentrating

• Preoccupation with the event

• Recurring dreams or nightmares

• Questioning spiritual beliefs

• Inability to process the significance of the
  event
• Learned helplessness, hopelessness

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Responses to Trauma - Emotional

• Depression or sadness

• Irritability, anger, resentfulness

• Despair, hopelessness, feelings of guilt

• Phobias, health concerns

• Anxiety or fearfulness

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Responses to Trauma - Behavioral

• Isolation from others

• Interpersonal conflicts

• Sleep problems

• Avoiding reminders of the event

• Crying easily

• Change in appetite

• Social withdrawal

• Talking repeatedly about the event

• Refusal to go to school

• Addictive behaviors

• Repetitive play

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Responses to Trauma - Physical

• Post Traumatic Stress Disorder

• Exacerbation of medical problems

• Headaches

• Fatigue

• Physical complaints with no physical cause

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Somatic Experiencing

• Trauma resolution modality developed by Peter
  Levine, PhD
• Trauma is an internal straitjacket created when a
  devastating moment is frozen in time. It stifles
  the unfolding of being, strangling our attempts
  to move forward with our lives. It disconnects us
  from our selves, others, nature and spirit.
• When people are overwhelmed by threat, we become
  frozen in fear.

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Somatic Experiencing

• Our instinctive trauma release systems are often
  inhibited by the ''rational'' portion of our
  brains. This restraint prevents the complete
  discharge of survival energies, and does not
  allow the nervous system to regain its
  equilibrium.
• The un-discharged survival energy remains
  stuck in the body and the nervous system. The
  various symptoms of trauma result from the body's
  attempt to ''manage'' and contain this unused
  energy.

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Somatic Experiencing

• SE allows the client to discharge the traumatic
  energy
• SE employs the awareness of body sensation to
  help
• people ''renegotiate' and heal their traumas
• rather than relive them.
• Ref Waking the Tiger
• Trauma Healing
• www.traumahealing.com

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Hakomi Method

• Originated by Ron Kurtz, this system is based
  on five therapeutic principles Mindfulness,
  Organicity, Non-Violence, the Mind-Body
  Connection, and Unity.
• It is a body-centered approach for which, in
  part, the therapist helps the client experiment
  with small changes in gesture or other movements,
  to see what differences occur in the processing
  of emotionally charged content
• (Ex the person might be observed to make a
  certain gesture or have a certain posture when
  talking about the attacker the therapist might
  suggest the gesture or posture be changed to a
  different one as an experiment, and then to
  notice the changes in feelings or thoughts).

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Somatic Psychology

• Developed by Pat Ogden, this treatment merges
  somatic therapies, neuroscience, attachment
  theory, and cognitive approaches, as well Hakomi
  Method.
• The approach often uses physical expression to
  process the energy stored in the body following a
  trauma, to reset the neurological system into
  better balance.
• (Ex the person might be asked to push the
  attacker away by forcefully pushing against a
  wall or against a pillow held by the therapist,
  to allow the body's neurological and musculature
  systems to reset themselves to a more normal
  level).

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Integrative Body Psychotherapy

• Developed by Jack Rosenberg and others, this
  system integrates verbal and cognitive methods
  with breath work and movement.
• It is built on the theories of many of the
  therapies that focus on early childhood, personal
  relationships, and existential issues, with a
  view that trauma sustained in the body/mind
  occurs very early and that subsequent trauma may
  recapitulate earlier trauma
• (Ex the client would breathe deeply to stay
  grounded and feel safe, and would recall and
  re-tellnot re-livethe incident, experiencing
  physical fear reactions such as shaking or
  contractions, and releasing these patterns
  through movement, words, or other means to
  re-pattern and dissipate the frozen energetic
  patterns).

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Cultural Differences in Response to Trauma

• Universal response is toward forming attachments
  and building community

• US Open discussion and expression

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Cultural Differences in Response to Trauma Asian
Americans

• Focus on interdependence and community

• Favor discreetness, non-imposition of feelings
  upon others

• Private discussion and expression
• Social withdrawal
• Flat affect, stoic attitudes
• Internalization of grief

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Cultural Differences in Response to Trauma Asian
Americans

• Japanese Passive dependency

• Helplessness
• Insecurity

• Chinese Somatopsychic expressions

• Headache
• Weakness
• Irritability
• Poor appetite

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Cultural Differences in Response to Trauma
African Americans

• Outward expressions with great emotion when
  social trauma

• Undercurrent of mistrust of authority

• Withdrawal
• Explosive anger or rebellion

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Cultural Differences in Response to Trauma
Latinos/Hispanics

• Desire to conform to culture of US

• Victims may try to blend in, avoid standing out

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Thank you

• Dr. Andrea Pennington
• The Pennington Institute for Health Wellness
• Isis Salon Therapeutic Spa
• 8505 Fenton Street
• Silver Spring, MD 20910
• 301-588-PENN (7366)
• www.PenningtonInstitute.com