Acupuncture as NADA protocol: Overview of the treatment of addictive behaviors

1 By Raben, Ralph

Treatment according to the NADA protocol serves as background therapy for people with addictive disorders, psychiatric patients and trauma patients. The key therapeutic element of this is the Ear. Treatment effects and treatment adherence are best when treatment is carried out in a group as large and open as possible. Its purpose, in addition to the reduction of symptoms, is to stabilize and strengthen debilitated patients, stressed and vegetative disorders. Because the patients could sleep better, concentrate better and better withstand the confrontations and challenges: increasing treatment adherence, which in addiction treatment is more successful in the detoxification of alcohol, drugs and drugs. Numerous studies confirm the efficacy of this treatment, imposed for 25 years in the United States, and for about 10 years also in several European countries. In Germany, about 230 psychiatric centers and helps people with addictive behaviors using the NADA protocol.

Key words: NADA Protocol, acupuncture, addictive behavior, addiction, alcohol, drugs, psychiatric, trauma, treatment group For some years the acu puncture has been used increasingly in Germany for the treatment of patients with addictive disorders. Currently apply about 230 outpatient centers and centers (as day hospitals, outpatient centers for alcoholics and drug addicts, hospitals, departments of general psychiatry, rehabilitation clinics, consultations in prisons, and clinics) as a formal element of the treatment of alcoholics, sick patients with psychiatric and addiction to drugs and medicines. 1. History Dr. HG Marx [9], student Bischko (Vienna), was first reported in the German-speaking area that acupuncture is an effective way to treat addiction of alcoholics and drug addicts. As a physician with expertise in addictive disorders observed and described the effects of acupuncture: decreased vegetative disorders and addictive irresistible urge (craving), improvement of physiological sleep, reducing seizures, improving compliance with all treatment, motivation enhanced phase of treatment and rehabilitation, favorable effects on teamwork of medical personnel in charge. However, in 1979 their experience had not been well received in the professional field. Dr. Wen [15], a neurosurgeon in Hong Kong, and had referred in 1973 to the point daily atrial pacing lung relieved symptoms of addiction to opium addicts and paved the detoxification phase considerably. Thus, staff Outpatient drug Lincoln State Hospital in the Bronx, New York, treated with this method to a large number of drug dependent patients with psychiatric disorders and also tried other complementary auricular points. He found a simple and effective combination of 5 auricular acupuncture points, and ultimately developed a "therapeutic setting" especially suitable for the treatment of patients cessation steady alcoholics, crack addicts, heroin, methadone and amphetamines [14 ]. It was shown that this type of auriculotherapy was effective regardless of the type of addictive substance and that it was also effective in patients was very upset and disturbed from the psychiatric point of view (bipolar disorder, patients with dual diagnosis, etc..). In the eighties the treatment of Lincoln Hospital in the Bronx became a model for intervention established and known in the U.S. as "NADA treatment according to the protocol." NOTHING Association was founded in New York in 1985 with the objective of implementing this treatment, scientific study and provide a good education and further training in this field. NADA stands for National Acupuncture Detoxification Association (National Acupuncture Detoxification). Its meaning in Spanish (no thing) well expresses its essence: treat patients without using chemicals, which from the point of view of an addict would not "nothing". 2. The NADA protocol in the world later also spread method, with various modifications, by several European countries. In Britain many thousands of therapists specializing in addictive disorders were trained in the clinical application of the NADA protocol. There, in addition to ambulatory and stationary treatment of patients with addictive disorders, is used in 60 prisons. In prison there is a huge problem worldwide addictive it impossible social reintegration of prisoners and prison violence generates. The NADA protocol is also widespread in Sweden, Italy and Hungary for 5 years in Denmark and Finland, and most recently in Switzerland.

Since Agethorst Clinic, specializing in drug addiction (currently Bokholt Clinic, near Hamburg), began conducting deshabituaciones without methadone or benzodiazepine-exclusively-acupuncture treatment, by the way, so far with great success in the last 10 years the method has also spread through Germany. In 1993 the association was founded NOTHING Germany. Participated in its foundation, as well as experts in addictive behaviors (as Dr. Michael Smith of New York, Dr. HG Marx and Dr. Carsten Gtersloh Eckernfrde Strau, both Germany) and therapists in this discipline (as Wolfgang Weidig Hamburg), acupuncturists experts (as John Tindall London Maciocia student, Walter Geiger in Hamburg, Munich and Jochen Gleditsch). Currently the association is still active and working NADA conxito in the field of ambulatory and stationary treatment of addictions, and also trains teams of general psychiatric units [2, 11]. 3. Protocol NADA NADA treatment procedure, ie the NADA protocol, combined with a structured style auriculotherapy treatment that is distressing to the patient. Mainly deals with the specific problems of patients who have psychiatric or addictive disorders, patients often extremely ambivalent changing adherence to treatment. Among others, this treatment protocol is appropriate:> to stabilize the patient even when still using alcohol and drugs > Generally getting a therapeutic approach to difficult patients > As supportive treatment during detoxification (alcohol and drugs) > For the symptomatic relief of side effects of drugs > As a measure of support for the psychotherapeutic treatment and rehabilitation > Primary treatment of psychiatric patients> for pregnant women addicted to alcohol or drugs > For the treatment of children and adolescents addicts > In order to support the cessation of snuff > As prophylaxis against relapse after drug treatment > To reapply immediate treatment in case of relapse, both outpatient and stationary. In short, the NADA protocol is suitable for ambulatory clinics, centers for drug addicts, prisons, day hospitals, including shelters for the "homeless" and also for medical consultations, provided that they can recreate their particular style of treatment. 3.1 Effects of the typical effects of acupuncture treatment are: > Relief vegetative disorders of addiction, such as, pain, nausea, tearing, inner restlessness, tachycardia, excessive sweating

> Stabilization and spiritual body> improved concentration simultaneous relaxation> anxiety reduction> sleep regulation> irresis reduced need tible (craving) with all addictive substances After acupuncture patients feel less anxious overall, are more stable, stronger, more awake and more alert, in short, more enduring. This has a positive effect on one of the main problems of psychiatric treatment and treatment of addictive behaviors: the strength of their motivation for treatment. Patients with addictive disorders with anxiety of some kind can hardly understand the therapeutic intent of healthy (doctor or therapist) of deshabituarles of an addictive substance. In conventional treatments for addiction, fear and lack of confidence in one's ability often result, after a short time, treatment dropout. This is expensive while frustrating for all. Therefore, in the NADA protocol cleverly combines acupuncture with other conventional elements sociotherapeutic and treatment of addictive disorders. Only then acupuncture achieves acceptance and overall efficiency in this complex field. The usual experience centers help people with addictive disorders incorporating acupuncture point occurs only lasting stabilization of patients when combined with acupuncture treatment. Should be noted that in practice "acupuncture applied to addiction medicine 'is not a few cleverly placed needles in places corresponding headphones and needles Obren expect a miracle, but most of the" experts acupuncturists addicts "also remind some of these patients as truly extraordinary cases. 3.2 Scenario of treatment has been shown that when dealing with difficult people, anxious and ambivalent, some forms of treatment sequence have great importance for the treatment of patients accepted and develop confidence in him. It is important to have a well-defined framework where acupuncture occurs. The following protocol elements have proven beneficial NADA for successful treatment: > Treatment takes place in group > Patients are seated> The treatment schedule is fixed (eg., Daily between 11 and 13 h) > The atmosphere of the room where the treatment is carried out not to be confrontational > All patients are accepted > Patients may also sit in the room without being placed needles (to see what happens) > The treatment must be carried out almost daily during the first 2 weeks > Patients drink several times daily infusion herbs 6 > Patients have the possibility of treatment and counseling

Difficult patients gain confidence when they realize that they are respected acupuncturist and has great dexterity. 3.3. Acupoints The stage treatment protocol used exclusively NADA auricular acupuncture. In the seventies was developed at Lincoln Hospital in New York a combination of simple but effective points. It was shown that helping patients to detox from alcohol, heroin, methadone, crack, cocaine, benzodiazepines, amphetamines and cannabis, and patients who had participated repeatedly in auriculotherapy much remained in the program conventional treatment (detoxification, therapy, rehabilitation, self-help groups). Smith et al [14] used the following points or areas (fig. 1):

Vegetative (sympathetic point): point 51 Shen Men (which means "gate of the soul" or "spirit door": point 55 Kidney: point 95 Liver: point 97 Lungs: point 101

The suitability of these points has been demonstrated to date hundreds of thousands of treatments. Apply 3-5 point needles in both ears. To do this, the points are "detected" (eg., By very-point technique or RAC). Nor tracking devices are used points. Acupuncture corresponding areas takes place with fine steel needles for single use (eg. From 0.2 13 mm) that are inserted to a depth of about 23 mm, so that the flag passes through the skin handset and the needle is fixed in cartilage. It helps the patient during puncture or asking her inspirations make short rapid breaths (contrarrespiracin technique). The combination of points has proven universally in many programs and psychiatric treatment of addictive disorders. Easy for patients to tolerate and for physicians, nurses and therapists, easy to learn and apply. Auriculotherapy is a low-risk technique and often shows an immediate effect on patients, even during the actual treatment session. Very depleted patients often fall asleep within minutes of starting to wake up about half an hour later. Another advantage is that, unlike body acupuncture, ear acupuncture has no contraindications this because the needle is not inserted into the muscle, which is a big advantage, because in this way can also treat patients who are not really " suitable for anamnesis "or who are being treated with inhibitors of blood coagulation. Difficult patients are not discouraged by having to answer many questions, maybe staying off treatment. Experience shows that after the first treatment or before the second or third interviews with patients become much more consistent because the patient is more "clear" and receptive. Thus acupuncture results in a more accurate diagnosis by a physician. 3.4 Chinese Medicine: Treatment of 'Fuego empty "Most alcoholics or drug addicts symptoms of excess Yang, both in daily life and during drug treatment. Sleep disorders are observed, sweating, nausea, vomiting, widespread pain, muscle tremors, and extreme inner restlessness, intermittent excessive aggression, anxiety and often expressed in so many words (sometimes incoherent speech). This designates symptomatology Chinese medicine with the right metaphor of "Fire

empty" or "Cold Fire" means a fire that does not heat. The reason for this appears often overflowing excessive symptoms normally resides in a weakness of the patient, ie in a vacuum and not in a fullness. The Yin Yin structural and functional different bodies slowly become weaker, according to each individual case, for reasons of lifestyle in constant chaos, chronic consumption of a substance, from a loss of structures (family, work, social benefits , housing, etc..) and malnutrition (spleen). So, overall there is a weakening of the functions Yin: especially, people lose their tone inner calm. The process often begins in childhood and youth, or inherited predisposition soon. Almost all alcoholics or drug addicts refer patients on history experiences intense mental or physical violence (often sexual). Traumatic experiences violent generate fear and terror, and greatly affect the heart (Shen weaken, the spirit, the soul) and kidneys. Naturally, fear, threat and helplessness generated arouse anger and aggression and anger when young can not defend or unknown (eg., Because everything takes place within the family). This situation occurs in the long term and undervaluation contempt of self and, according to Chinese medicine, a weakened liver. In violent families, as in PTSD, grief is suppressed by these experiences and constantly repressed. Thus, the trauma of the past is not exceeded and remains unresolved (the "lung function" of exhalation and detoxification). Therefore, nothing can not originate new development and stagnates person (Chinese "lung damage"). Many of these patients are anchored in an infantile or juvenile mental development. Acupuncture plays here the role of strengthening the individual and gradually moving relocating stagnation in order to bring about change and development. This is what they see regularly assigned acupuncturists and therapists in their patients: see art of acupuncture as the "midwife of the spirit", as Michael Smith put it in his presentation at the NADA Conference in Hamburg in September 2003. NADA treatment is a treatment originated from Yin. What does this mean? It means that the treatment is aimed at creating structures. The research was developed following a few simple rules that can meet the patient, and this strengthens. The patient sits, maintains control, instead of lying and having to 'surrender', and goes on a defined schedule. During acupuncture tranquility reigns, organization and serenity. The patient feels that he is better even during acupuncture, but he has entered no "substance". So the typical question is "but what was the needle?. The group is a strong and natural structure in which the patient can be easily integrated if not faced with words and questions, nor was he afraid before acupuncture can consistently develop their balancing effect. Your goal is not calm, sedate or only reduce symptoms but better stability and a strengthening of the person, to rediscover the inner self calm tone. The patient should be more awake and alert. For example, the goal that can hold the gaze, conversation, therapy, another person, confrontations or support itself. This is to avoid first the drug dealer and the bar, and then can even withstand the treatment. That is, to control the past and prepare for the future. When reinforces Yin excess symptoms become weaker Yang. 4. Scientific research randomized controlled studies in patients with psychiatric and addictive disorders The results of numerous scientific studies on the effectiveness of acupuncture for treating addictive disorders, some randomized, single blind, and

some made with a large number of patients are far contradictory. There are many studies and analyzes that show a clear effect of the NADA protocol regarding clinical recovery of patients with addictive disorders (eg., 1, 3, 5, 6, 7, 12, 14 and 15). There are also studies comparing the "true acupuncture" and "sham" (placebo) for the treatment of addictive disorders that do not show a significant difference in the efficacy of both protocols [8]. Lately studies dealing with the effectiveness of the NADA protocol in general psychiatric diseases [4]. The main problem resides in the design of these studies. The acupuncture treatment, especially in patients with psychiatric and addictive disorders, always develops differently to drug treatments:

The aspect of the relationship with the patient plays a key role, so that hardly lends itself to a double-blind. The tuning of the therapist with the patient, the patient's present inner attitude, your perception of what happens at the time of treatment, all of which have a function, similarly to what happens in psychotherapy.

In acupuncture healing process is stimulated not only by the needle, but also by the ratio of one person to another. The fact that a patient ambivalent hard again the next day or leave (saying "acupuncture does not help me" or "acupuncture hurt me") relies heavily on factors specific to the verbal and non-verbal interaction between therapist and the patient. Respect, kindness, dependability, the ability, to some extent the "good behavior" of the acupuncturist play a dominant role in psychiatric patients, who often have their backs always many failed attempts at treatment, showing a low adhesion almost all treatments, thus maintaining the addictive substance (for example, treatment with heroin or methadone). In a study in which the acupuncturist knows to apply "sham acupuncture" many more things are changed in the stage of treatment that only the location of the points. Amending, for example, the "inner attitude" of the "therapist" about their therapy and its "under investigation." Arguably, the moral true therapeutic treatment is different from that of a research project with many specifications and standardizations. In my view, a reasonable study could include a support center for drug addicts who have integrated into their addiction treatment and rehabilitation NADA protocol in conjunction with other therapies, and that for a long time comparing with other similar centers that work without the NADA protocol. Then it would be interesting to analyze how good the "outcome", how long recurrence-free interval and what the rate of patient stays in the program. However, to date, most studies are wanting to know if the insertion of the needle itself produced any effect. 5. Training as a "therapist NOTHING 'training as an acupuncturist to treat people with addictions should not be limited to teaching students to insert the needles properly and safely in the right spots. Those who work with the NADA protocol must learn to deal with a lot of respect for their patients in any difficult situation ("leave me alone, man!") Plus non-verbally convey that while his patient is so scared, ambivalent, " impossible and chaotic "and is so tense, will also be accepted and respected, but, despite that there are limits. Otherwise, many acupuncturists and treatment centers will no longer see many of his patients. This aspect too briefly contemplated in many training courses extensive and detailed about acupuncture.

The association is NOTHING at all that deal professionally with psychiatric or addictive disorders. Mainly provides training, often in situ, to whole groups of doctors, nurses, orderlies and therapists. Often, in the second year and working with patients. Thus bilateral acupuncture takes a considerably more formal character. Training is provided in two full weekends, at basic levels I and II, and it takes a theoretical and practical examination, and practices of 20 h in a facility that is already using the NADA protocol. Normally, courses are taught by two experienced trainers and acupuncturists in groups of 20 students. Synopsis The NADA protocol is a concept that combines acupuncture treatment with conventional therapeutic elements. It is simple and effective and can be easily integrated in all psychiatric therapeutic approaches, oriented psychotherapeutic and addictive behaviors. The treatment style not particularly confrontational and simplicity of auricular acupuncture may also be made difficult patients ambivalent participate regularly and repeatedly in acupuncture treatments. The NADA protocol is being increasingly introduced in outpatient and stationary as a rigorous daily treatment of the mentally ill and people with addictive disorders-long not only for detoxification treatment of patients with addictions. Mailing Address Dr. med. Raben Ralph NOTHING Vorsitzender Deutschland Ottenser Hauptstrae 33 D-22765 Hamburg ralphraben@web.de NOTHING kontakt@nada-akupunktur.de www.nada-akupunktur.de

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6. Buhk H, Busch W, Feldkamp J, Koch U. Ergebnisse einer Studie von zur ambulanten Akupunkturbehandlung alkoholund medikamentenabhngigen Klienten in einer Beratungsstelle. Suchttherapie 2001, 2: 35 to 44 7. Bullock M, Culliton P, Olander R. Controlled trial of acupuncture for severe recidivist alcoholism. Lancet 1989; 1: 1435-1439 8. Bullock M, Kiresuk T, R Sherman, et al. A large randomized placebo controlled study of auricular acupuncture for alcohol dependence. J. Substance Abuse Treatment 2002; 22: 71-77 9. Marx HG. Medikamentenfreie Entgiftung von Suchtkranken. Bericht ber den Einsatz von Akupunktur. Suchtgefahren 1984, 30-34 10. Raben A. Akupunktur in der Behandlung drogenabhngiger Schwangerer. Dt Ztschr. f. Akup. 1998, 41, 2: 38-42 10. Raben A..: Einfhrung in die nach dem Ohrakupunktur Protokoll NOTHING. In: Baudis R, ed. Der Wandlung Punkte - Suchtakupunktur nach dem Protokoll NOTHING. Rudersberg: Verlag fr Psychologie, Sozialarbeit und Sucht; 1999: 16-37 11. Shwartz M, Saitz R, Mulvey K, Brannigan P. The value of acupuncture detoxification programs in a substance abuse treatment system. J. Substance Abuse Treatment 1999; 17: 305-312 12. Smith MO. Acupuncture treatment for crack: clinical Treated patients surveyof 1500. Am J Acup. 1988, 16: 241-247 13. Smith MO, Khan I. An Acupuncture Programme for the Treatment of Persons Drugaddicted. Bulletin on Narcotics 1988; 40.1: 35-41 14. Wen H, Cheung S. Treatment of drug addiction by acupuncture and electrical stimulation. Asian Journal of Medicine 1973; 9: 138-141 Raben, Ralph NOTHING to Vorsitzender Deutschland Ottenser Hauptstrae 33 D-22765 Hamburg ralphraben@web.de And Translation of Via :: http://www.elsevier.es Make a cute label for the bottle. I used stamps and ink. Enjoy! Free courses, caring, medical care, humanitarian events http://www.facebook.com/events/488585067868745/ :-) Natura Essential -....-Oooo-oooo ... Essential start + Look!

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