By Miles E. Drake, Jr., M.D.
A Change In The Paradigm of the 12 Step Program May Be The Introduction of Alternative Therapies Used in Europe and China for Hundreds of Years
The problematic use of alcohol and drugs has apparently been present throughout history. Archaeological records indicate the use of plants with psychotropic effects by early hominids, and Australian aborigines may have derived a nicotine-like substance from indigenous plants some 40,000 years before European colonization. Evidence of the intoxicating use of betel nut 10,000-15,000 years ago has been found in Thailand and Timor. South American civilizations used cocaine 5,000 or more years ago, and the ephedrine-like stimulant khat was used in North Africa and Ethiopia for centuries before the first European arrival (Saah, 2005). As for alcohol, its effects may have been discovered by the accidental consumption of fermented material, but some kind of wine was in use in China by around 7000 BCE, and sura derived from rice was both an intoxicant and an anesthetic in India by 3000 BCE. The Babylonians worshipped a wine goddess around 2700 BCE, and Egyptians records indicate that the god Osiris invented beer. The Egyptians brewed 17 different kinds of it and 24 varieties of wine for frequently boisterous use in this world to be stored in tombs for the after-life, and both religious and medical texts warn of the dangers of immoderation (Chafetz, 1967).
Through much of subsequent history, excessive use of alcohol was either accepted or subjected to moral opprobrium by abstainers; there were occasional outbreaks of alcohol abuse that were thought to require public attention and remediation, such as the English Gin Craze in the 18th century, but more often than not alcoholic preparations were thought to be medicinal as much as recreational (Lucia, 1963). Opiates and other psychoactive drugs began to be increasingly available from the Renaissance on, with the development by Paracelsus and refinement by Thomas Sydenham of laudanum, an alcoholic tincture of opium, which in turn gave rise to the great proliferation and widespread use of alcohol and opium-containing patent medicines during the 18th and 19th century (Davenport-Hines, 2004).
The isolation in 1804 and marketing in 1827 of morphine was felt to be a great advance, but its widespread use during the Civil War led to the recognition of the “soldier’s disease” of opioid addiction in the war’s aftermath. Attempts to mitigate the adverse effects of opioids made the problem worse, because these largely took the form of cocaine administration, advocated by figures as eminent as Sigmund Freud and Pope Leo XIII, and the development of diacetylmorphine or heroin, marketed as a wonder drug by Bayer in 1898. This has been followed by a long, complex and frequently ineffective attempt at drug interdiction, prosecution and attempted rehabilitation, particularly in the United States (Musto, 1999).
Alcoholism treatment in the United States began with Benjamin Rush, physician and signer of the Declaration of Independence, who suggested in 1784 that alcohol abuse was a disease that should be treated medically, and who advocated the establishment of “sober houses” for the care of drunkards. The building of asylums for inebriates as well as lunatics was advocated in New York state by Samuel Woodward in 1830, and this came to fruition with the opening of lodging homes in Boston in 1844, followed by a Home for the Fallen in 1857. The New York State Inebriate Asylum was opened in Binghamton in 1864, and Chicago’s Martha Washington Home for alcoholic women in 1867. These and a growing number of institutions soon began to treat addiction to other drugs as well. Dr. Leslie Keeley, who advertised that “drunkenness is a disease and I can cure it”, established 120 Keeley Institutes across the country in the 1880s and was the progenitor of the for-profit sanatoria and treatment centers of the next century. Inpatient treatment waxed for a time and then largely collapsed as a result of the institution of alcohol prohibition in 1919, and the establishment of federal control of narcotics by the 1914 Harrison Act followed by the 1919 Supreme Court decision (Webb v. United States) that physicians who prescribed opiates for the treatment of opiate addiction were not practicing “good faith” medicine and could be prosecuted under that act (and 25,000 were between 1919 and 1935). At the end of this period, the influential 12 step principles elucidated by Bill Wilson after treatment in one of these alcoholism facilities became the basis for first Alcoholics Anonymous, and then similar organizations addressing narcotic, cocaine and multiple other addictions (White, 1998).
Treatment centers eventually recovered and medical treatment of alcoholism and addiction was greatly strengthened by the “Minnesota model” of synergistic treatment between state hospitals and rehabilitation facilities, the introduction of drug treatments ranging from Antabuse to LSD around 1950, the recognition of the medical basis of alcoholism and addiction by the American Medical Association in the 1950s, the elucidation of the “disease concept” of addiction in 1960 and the introduction of methadone treatment in 1964. Increasing involvement and funding by the federal government, the development of the specialty of addiction medicine and educational programs for drug and alcohol counselors, the resultant accreditation standards for treatment facilities and licensure regulations for treating professionals and the availability of multiple drugs for the treatment of addiction and withdrawal eventuated by the early 21st century in a very large-scale medically-oriented treatment system, frequently characterized by inpatient hospitalization followed by outpatient therapy and dominated by the 12-step program. This approach has been increasingly criticized and alternative treatment approaches advocated by therapists such as Stanton Peele (1999), who argue that addiction is for many people an intermittent or short-term life problem. It has also been suggested that addiction be reconceptualized and managed as a chronic medical disorder in an office setting as much as possible (McLellan, Lewis, O’Brien & Kleber, 2000).
There are many alternatives to hospitalization and pharmaceutical treatment for alcoholism and addiction to other drugs. Many of these have been recognized since ancient times and have been used in various cultures for problematic substance use. This review does not advocate their sole use without medical or addiction medicine input, and it is generally agreed that certain circumstances such as alcohol, barbiturate and benzodiazepine withdrawal cannot be safely managed without conventional medical approaches. Psychological or spiritual support for the life changes necessary to overcome addiction is also generally felt to be important. Complementary, holistic or natural medicine has much to offer for the treatment of substance use problems, however (Holistic Light Addiction Treatment Center).
HOW TO IDENTIFY AN ALCOHOL OR DRUG PROBLEM
Many diagnostic criteria for addiction have been proposed in recent years. The American Psychiatric Association (2013) has recently replaced the former, sometimes interchanged and often confusing diagnoses of abuse, dependence and addiction with the general rubric of substance use disorders, which can involve any substance from alcohol to khat. The new DSM-5 criteria involve 11 potential problems arising from using a substance excessively or inappropriately:
Taking the substance in larger amounts or for a longer period than was planned
Wanting to stop or cut down on use of the substance but not being able to
Spending much time getting, using and recovereing from the effects of the substance
Cravings and urges to use the substance
Difficulty in performance at work, school or home because of substance use
Continued use even when this causes relationship problems
Giving up occupational, social or recreational activities because of substance use
Continuing to use substances even when this causes danger
Continuing to use substances even with physical or psychological problems caused or worsened by the substance
Tolerance or needing more of the substance to experience the same effect
Withdrawal symptoms when not using the substance, which can be relieved by taking more of the substance.
Many questionnaires and diagnostic interviews have been published to help individuals with drug and alcohol problems recognize them. A 20-question instrument to identify alcoholism was developed in the 1930s by Johns Hopkins psychiatrist Robert Seliger, and focuses on family, social and occupational loss due to use and use to escape worries and problems, with more positive answers indicating more severe addiction (Seliger, 1954). The Michigan Alcohol Screening Test (MAST) initially utilized 21 and later 10 questions about emotional, physical, economic and legal consequences of substance use, with further evaluation warranted by 3 to 6 “yes” answers (Pokorny, Miller & Kaplan, 1972). Commonly used and extensively validated for alcoholism but less so for other addictions, the CAGE questionnaire simply asks whether one has felt the need to Cut down on drinking, Annoyed when other people criticize one’s drinking, Guilty about one’s drinking or needed an Eye-opening drink to start the day, with 2 or more endorsements being a positive result (Ewing, 1984). A common aphorism in clinical practice, particularly when considering the safer and less costly interventions of natural medicine, may be that when you think you have a drinking or drug problem, you may well have a drinking or drug problem.
DIET AND ADDICTION
Blood sugar variability and in particular hypoglycemia are felt by many addiction and natural medicine specialists to be a crucial part of alcoholism. Alcohol or drug abuse of any severity or duration can produce significant nutritional derangement, and alcohol and most drugs cause significant damage over time to almost all organ systems that nutrition is important to repair. Well-balanced meals, preferably smaller ones several times a day, with an emphasis on fresh fruits, vegetables, whole grains, beans, nuts, seeds and lean animal protein will assist in restoring nutritional balance and stabilizing blood sugar levels. Sleep disturbances are common in the early phases of abstinence, and may be improved by a bedtime snack of turkey or chicken as a source of the serotonin precursor and sleep facilitator tryptophan. Although the early literature of Alcoholics Anonymous advocated carrying a candy bar in case of hypoglycemia, avoiding refined sugar that will send the blood sugar soaring and then crashing is currently recommended, along with avoiding caffeinated beverages that can trigger craving. Alcoholic beverages should be avoided by people whose problems are with other drugs because of the risk of cross-addiction (Holford, 2004).
Alternative therapies are an approach that has been used in Europe and China for hundreds of years. Alternative therapies are not appropriate for people to use without the guidance of alternative therapy practitioner because such practitioners are experienced at identifying problems that people with addictions may not fully realize, can measure progress, adjust when necessary and quantify results. Whether it is aroma therapy to make you feel better or helpful vitamins and supplements, alternative therapies may offer a positive solution to overcome the obstacle of addiction. It is important to note all forms of therapy may pose a risk for side effects and combining alternative therapies with traditional medication may elevate risks. This particularly holds true for combining anti-depressive medication with alternative therapies.
DETOXIFICATION FOR ADDICTION
Many nutritional and naturopathic authorities recommend periodic fasting and detoxification for health maintenance and treatment of various problems. This is not recommended for those who are embarking upon abstinence or experiencing withdrawal, but supervised detoxification protocols may be helpful after withdrawal symptoms subside to help eliminate the various poisons that have been consumed and toxic byproducts that have accumulated. Detoxification may take up to four months of optimal nutrition punctuated by monthly fasts of one or two days, with copious amounts of nutritious broths, calming herbal teas, juices and clean water during these. Many people who abuse various substances have neglected fiber intake and are severely constipated, and this is also a natural effect of opioids. Fiber, fluids, stool softeners, gently-stimulating laxatives that are not cathartic and probiotics are appropriate to alleviate this (P. Balch, 2010).
NUTRITIONAL SUPPLEMENTS FOR ADDICTION
The supplementation of the diet with vitamin and mineral preparations is sometimes called “orthomolecular (correct molecule) medicine” and has strong advocates in the addiction field, although these nutrients should be used carefully and in a pure form. A high-potency multivitamin preparation preparation will assist detoxification and stabilize mood. B-vitamins are particularly important in this regard and are generally depleted after a period of drug or alcohol abuse, and 50 mg. daily of a B-complex is effective. Chromium plays an important role in stabilizing blood sugar and thus alleviates cravings: 200 mcg. two or three times daily is a common recommendation. The amino acid l-glutamine 500 mg. three times a day on an empty stomach will improve energy levels and stabilize mood, both of which can fluctuate for long periods, both during the period of immediate withdrawal and in the post-acute withdrawal period that can last for up to a year. The serotonin precursor 5-hydroxytryptophan will help with depression and anxiety, and should be taken three times daily (100 mg.) on an empty stomach; this should not be taken along with serotonin-affecting antidepressant or antianxiety medications, however.
Less important but still helpful nutritional recommendations include d,l-phenylalanine for depression and fatigue, usually 500 mg. three times a day between meals. Calcium (500 mg. twice daily) and magnesium (250 mg. twice daily) help with the common tension, tremor and muscle cramps and twitches. Niacin (vitamin B3) was strongly recommended for alcoholism in the days of AA, including by Bill W. himself, and may now be underutilized because of the occasional occurrence of disagreeable flushing of the skin from blood vessel dilation; a nonflushing form (inositol hexaniacinate) is available, and can be taken 500 mg. twice a day. N-acetyl-cysteine, a derivative of the amino acid cysteine, increases levels of glutathione, which may be the most important antioxidant, and has been a beneficial adjunct for treatment of drug addiction: the usual dose is 300 mg. three times daily. Vitamin C also increases glutathione levels, and augments antioxidant effects as well as detoxification at recommended dose of 1000 mg. three times a day. Many classic complications of alcoholism, particularly memory disorders, are due to depletion of thiamine (vitamin B1), and supplementation with 200 mg. a day or even intramuscular or intravenous injection by a physician may be appropriate (Hoffer & Saul, 2009).
HERBALISM FOR ADDICTION
The use of plant components and derivates for alcohol abuse dates back to classical antiquity in the west, and has long been part of the Chinese, Indian and native American medical traditions. Milk thistle (Silybum marianum) is a potent liver regenerator and supporter of detoxification, and can be taken 250 mg. two or three times a day; a produce standardized to an extract of 85 per cent silymarin, the plant’s chief active ingredient, is recommended. Saint-John’s wort (Hypericum perforatum) augments central serotonin levels and improves mood and energy, as well as being an immune support. It should not be combined with antidepressant medications because of the danger of excess serotonin (serotonin syndrome), but can otherwise be taken 300 mg. three times daily, in tablets or capsules standardized to a 0.3 per cent hypericin extract. Superfoods or green food supplements like the bacterial extract spirulina or the alga chlorella are plants but make their food by photosynthesis as plants do, and are advocated for support of detoxification as well as their nutritional content. Anxiety is one of the predisposing factors for alcoholism and drug addiction and frequent occurs in recovery, so passionflower (Passiflora incarnate), hops (Humulus lupulus), oatstraw (Avena sativa) and valerian (Valeriana officinalis) are often helpful, usually taken three times a day as a capsule or 3 ml. of a tincture, or made into a calming tea. The South Pacific herb kava (Piper methysticum) has been shown in controlled trials to be more effective than a placebo for anxiety; its legal status is unclear because of reports of addiction and liver toxicity that have led to its prohibition in some countries, but it is legal in the United States although chiefly used as tea. The Indian medicinal plant reishi (Ganoderma lucidum) is reported to improve concentration and focus and to enhance liver function and the immune system; 800 mg. twice daily is recommended (Stengler, 2010).
HOMEOPATHY FOR ADDICTION
Homeopathy, introduced in 1790 by Samuel Hahnemann, is the doctrine that symptoms are best treated with very dilute preparations of substances that at full strength will cause those same symptoms in healthy individuals. Such “provings” have not induced alcoholism or drug addiction but have in some cases demonstrated some of the mental and physical symptoms of addiction and withdrawal; in addition, clinical experience over two centuries has indicated that certain remedies will work best for people with certain physical and mental characteristics of “constitutions”, which may include the predisposition to addiction. The long-standing objection of conventional medicine that homeopathic preparations are so far diluted that they cannot contain any molecules of the original substance has been disproven by the methods of physical chemistry, which suggest that the water molecules in these remedies are indeed changed in a way that can impart information to body tissues which may trigger physiological changes. The other objection, that there is no evidence that these remedies work, has been challenged by controlled trials that suggest that homeopathic medicines may in some situations be as effective as pharmaceutical drugs. Homeopathic preparations are essentially free of side effects and are much cheaper than most conventional medicines (Vithoulkas, 2014).
Homeopathic remedies are generally sold as lactose tablets or pellets, labeled according to the number of times a 10:1, 100:1 or 1000:1 dilution has been made of a “mother tincture” in which an animal, mineral or vegetable substance has been dissolved. For example, a “6X” preparation has been diluted 6 times by a factor of 10 and a “30C” tablet represents a 1-to-100 dilution repeated 30 times. Although very dilute, the latter is considered stronger by homeopaths, as the active principle has been concentrated and the potential for side effects eliminated. The usual recommendation is to take a 6X, 12X, 6C, 12C or 30C potency twice a day for two weeks and then stop; if symptoms persist or worsen during this time another remedy or potency should be tried, and if symptoms improve but then recur after the dosing is stopped, the remedy should be tried again.
Arsenicum album (arsenic) is indicated for restlessness, fatigue and anxiety, which may be accompanied by burning pain lessened by warmth; symptoms are often worse between midnight and 2 a.m. Ignatia amara (St. Ignatius bean) is helpful for emotional lability, with constantly changing mood and symptoms, intense tearfulness but also the strong desire to be left alone, “globus hystericus” or the sensation of a lump in the throat, anxiety and muscle twitches and spasms; people who respond to Ignatia often harbor long-standing anger and resentment. Lachesis mutus (bushmaster snake venom) works best for people who are angry or violent, or are jealous and paranoid. They are often warm and feel worse in heat, and cannot tolerate anything touching the throat. Lycopodium clavatum (club moss) has been particularly used for alcoholism and addiction, especially with irritability and low self-esteem; such patients often feel chilly and are better when warm, crave sweets and have digestive symptoms like gas and bloating. Nux vomica (strychnine tree nut) is a poisonous excitatory neurotoxin in nature, and may for that reason be particularly useful for excessive nervous excitability in homeopathic dilution; it is particularly effective in withdrawal attended by sensitivity to light and sound, and in people with past or family history of alcoholism. Nausea, constipation, chills and fatigue are other addiction-related symptoms that suggest its use. Sulphur has been used for people with alcohol craving and binge drinking, often associated with skin rashes, craving for spicy foods and undue warmth alleviated by cold air and drinks (Balch & Stengler, 2010).
FLOWER REMEDIES FOR ADDICTION
Flower remedies are related both to herbal medicines and to homeopathic preparations. They are prepared from the essential oils of flowers and seek to alleviate psychological states or emotional conflicts that precipitate or worsen physical illnesses. The best known system was developed in the 1920s by Edward Bach (he pronounced it “batch”), a British homeopathic physician who experienced the spontaneous remission of an apparent malignant liver tumor and then closed his lucrative London practice and retired to an Oxfordshire farm to develop natural remedies. Bach prepared tinctures of 38 common British wildflowers and found that they enhanced psychological well-being in certain types of people and made their medical problems easier to manage. These essences have been used with benefit in addiction and withdrawal, and are usually taken in the form of 10 drops under the tongue or in a glass of water. A combination preparation, Rescue Remedy, is the best-selling natural medicine product and includes the essences of cherry plum, clematis, impatiens, rock rose and star of Bethlehem; it is effective for panic, anxiety and acute stressjful situations. Aspen is recommended for persistent vague fears, cherry plum for violent thoughts or impulses, crab apple for guilt or shame concerning alcoholism or addiction, holly for persistent insecurity that is concealed behind a mask of hostility, mustard for symptoms of depression and star of Bethlehem for an acute crisis or a persistent state of shock (Blöme, 1999).
AROMATHERAPY FOR ADDICTION
Also related to herbal medicine as well as the flower remedies is the old but also new technique of aromatherapy. The essential oils of various aromatic plants have been used for religious ritual, embalming and cosmetics and perfumes from ancient times and had some medicinal use until around the 18th century. Interest in the healing powers of essential oils was rekindled in 1910, when the French perfume chemist René Gattefossé burned his hand in a laboratory accident, dipped the hand in oil of lavender because nothing else was around and noticed that the burn was substantially healed. French military physicians observed therapeutic benefits from plant oils during the Second World War, and the Austrian biochemist Marguerite Maury developed in the 1960s the technique of individually-prescribed preparations of aromatic oils that is widely used today. The oils are toxic and must not be taken internally; many can also irritate the skin, so must be added to a bath in small amounts, vaporized and diffused in a room or mixed with a carrier oil and used for massage. Juniper oil is widely used to break up toxins and speed their elimination through the skin; oils of lavender, bergamot and chamomile have antidepressant and antianxiety effects, and bergamot can also reduce cravings for food and alcohol (Cooksley, 2002).
BODYWORK FOR ADDICTION
Bodywork refers to treatments applied externally to the body that reduce stress and facilitate healing. People who are attempting to change their lives and habits drastically are likely to feel stress, fatigue and low energy, and these are areas in which bodywork techniques can be helpful. Massage therapy, craniosacral manipulation, Reiki, therapeutic touch and acupuncture must be administered by a therapist. Some kinds of massage can be given at home by friends and family, and acupressure and foot reflexology can be done by anyone.
Massage is preferably given over the whole body by a professional therapist. Treatments often focus on the lymphatic system, which removes bacteria, white blood cells and toxins that have been captured in lymph nodes throughout the body. The lymph nodes play a role in detoxification from illness, injury or addiction, and may be overtaxed in some toxic states. Unlike the arteries and veins, the lymphatic vessels have no central pump, and flow is dependent upon muscle contraction to move fluid; the deep breathing and muscle manipulation that are part of lymphatic massage may enhance lymphatic flow and more effectively remove toxins. A head massage is an alternative to full-body or lymphatic massage that can be taken at home, and that is particularly beneficial for the nervous system as the head and neck are particularly nerve-rich areas. The patient receiving the massage should lie flat on his or her back , and the person administering the massage should hold the head in both hands and make small circular motions with the fingers, working upward from the base of the skull into the hair, over the temporal regions onto the sinuses, then down the sides of the nose and over the mouth, combining strokes and light taps over the face. A similar circular massage can be given to the foot, which will bring energy down from the head and produce relaxation and warmth (Black, Jacques, Webber, Spurr, Carey, Hebb & Gilbert, 2010).
Craniosacral therapy is a form of manipulation and massage that attempts to facilitate the flow of cerebrospinal fluid around the brain and spinal cord by gentle pressure on bones of the head, spine and pelvis. Its began as cranial osteopathy, whose founder, Dr. William Sutherland, suggested that the apparently fused bones of the skull might nevertheless move very slightly relative to each other, like the gills of a fish, and that these movements might be caused by rhythmic pulses, perhaps related to respiration. Drs. John Upledger and Ernest Retzlaff subsequently proposed that normal rhythmic pulses of cerebrospinal fluid flow around the brain and spinal cord could under some circumstances be dampened or restricted and cause or contribute to illness, and that manipulation of cranial and spinal bones could alleviate blockage and normalize flow; they also suggested that the manipulation normalizes the flow of life-force energy within the nervous system, and that “entrainment” of the patient and the therapist during treatment allows stagnation or blockage of energy to be relieved. The benefit of craniosacral therapy for medical or mental disorders has not been established by controlled studies, but it is generally agreed that the technique is helpful for stress management and relaxation in stressful health situations (Upledger, Ash, Grossinger & Cohen, 2008).
Reiki is another form of energy medicine that alleviates stress and facilitates relaxation and well-being through the laying on of hands. The name is a combination of the Japanese words Rei (Higher Power) and ki (life-force energy, similar to the Chinese chi or qi), and the technique is derived from Buddhist and Hindu healing and spiritual practices. Reiki itself was devised in 1922, however, by Dr, Mikao Usui, who suggested that a therapist could transfer ki to a patient with blocked or deficient energy by a combination of meditation and manipulation and thereby improve illness or distress. After Usui’s death in 1926, Dr. Chujiro Hayashi simplified and systematized the somewhat mystical technique, and attracted much attention in Japan by the successful treatment of psychomatic illness. Hayashi was consulted in 1937 by Hawayo Takata, a resident of Hawaii who had become seriously ill while visiting relatives in Japan; Mrs. Takata recovered completely and with difficulty persuaded Hayashi to teach her his technique. Hayashi had been an Army physician and became an ardent pacifist; he committed suicide rather than rejoin the Japanese Army at the outbreak of World War II, and Mrs. Takata carried the Reiki technique to Hawaii, where many American practitioners were trained. Reiki practitioners treat addictions by focusing and rebalancing energy in the 1st or root Chakra, located at the base of the spine, as well as the 3rd (solar plexus), 6th (brow) and 7th (crown) Chakras, which influence cravings and urges, personality, thoughts and beliefs and emotions, respectively. The solar plexus is also involved with digestive and nutritional disorders. The existence of unseen life energy and the efficacy of Reiki are not accepted by many adherents of Western medicine, but there is scientific evidence and some controlled clinical trials in its support (Shewmaker, 2003).
Acupuncture and acupressure derive from traditional Chinese medicine, but are supported by an increasing number of Western clinical studies. Both techniques attempt to harmonize life-energy (qi) that flows through the 12 main channels (meridians or jing luo) and multiple subsidiary channels by stimulating certain points that regulate particular organs or systems. The acupuncturist has been likened to a piano tuner, who adjusts sharp or flat notes in order to re-establish a harmonious whole. Western studies of acupuncture suggest that the technique increases production of endorphins and may be helpful in conditions in which these are deficient or exhausted, such as chronic pain and addiction. By augmenting endorphin levels, acupuncture may also help with inappropriate eating or sugar cravings. Acupuncture requires the insertion of needles by a therapist, but acupressure can be dome simply by massaging or pressing certain accessible acupuncture points. Applying pressure to a point for 30 seconds to a minute will cause relaxation and calm. Slow circular rotations with squeezing, like kneading dough, will gently stimulate the organ concerned; vigorous rubbing, as of hands that have just been in extreme cold, is more vigorously stimulating and is thought to increase the flow of qi if needed.Tapping acupressure points will stimulate the muscles related to them. There are as many as 400 acupuncture points, depending upon the classification system used, but two major points are generally recommended to block cravings(Small Intestine 19 and Liver 14),and two others are helpful to alleviate anxiety and enhance well-being (Spleen 16 and Stomach 36)/. Small Intestine 19 is just below and in front of the external ear, in a depression created when the mouth is opened, and Liver 14 is on the back of the hand at the intersection of the thumb and index finger. Spleen 16 is at the midpoint of the lowest rib on either side, while Stomach 36 is at the outer side of the shin just below the kneecap. There has been much debate about the mechanism and effectiveness of acupuncture, but the number of people electing to receive acupuncture treatment in the United States has increased from 0.5 per cent in the 1990s to about 5 per cent today. The World Health Organization and the National Institutes of Health have concluded that acupuncture (and acupressure) are appropriate for clinical use, the German health insurance system concluded after the largest trials to date of acupuncture treatment between 2001 and 2006 that acupuncture was appropriate for painful conditions and the National Health Service of the United Kingdom has determined that there is about equal evidence for and against the effectiveness of acupuncture (Carter, Olshan-Perlmutter, Norton & Smith, 2011).
An individual with alcohol or drug problems who is trying to quit is in much the same position as the patient in one of Groucho Marx’s routines. The patient states that it hurts every time he goes like that, and Dr. Groucho replies, “well, don’t go like that”. The current paradigm for stopping going like that often involves inpatient rehabilitation, outpatient therapy, prolonged or lifelong commitment to the 12-step model of drug and alcohol recovery and frequently pharmaceutical drug treatment. This is effective, but perhaps for only a minority, and is expensive and has also been effectively criticized. A large number of other effective treatments using nutritional supplementation, herbal medicine, homeopathy, essential oils and various forms of bodywork are also available, and in some cases have been in use for centuries at relatively low cost and with few if any adverse effects. The proposed reconceptualization of alcoholism and drug addiction as either short-term problems of life or chronic medical conditions requiring outpatient management may make these natural or complementary approaches appropriate for consideration by physicians, counselors, patients and families.
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