"It's the best relaxation, anti-anxiety drug I've ever had," says Hank. "It’s better than a Valium or Lorazapam or anything from the past."
In fact, it’s not a drug at all.
Hank (not his real name) is talking about ear ("auricular") acupuncture, a cornerstone of recovery for clients at the Substance Abuse Treatment Unit (SATU).
SATU, Connecticut Mental Health Center's premier clinic for individuals with substance abuse disorders, offers a simple five-point ear acupuncture protocol to all of its clients. Some, like Hank, have been receiving the treatment for years.
"This is a calling for me," says Katurah Bryant, RN, LMFT, Associate Director of SATU and the founder and supervisor of the clinic's acupuncture program. "It's not a cure for addiction, but it is one tool in the tool belt for recovery that we’re trying to get clients to establish for themselves."
One of the oldest healing arts in the world, acupuncture has been practiced in Asia for thousands of years. Scientists don't fully understand why or how it works. At SATU, says Bryant, "We don’t dwell on the 'whys.' We just know that clients seem to benefit from the intervention. It gives them some relief from symptoms of their addiction."
For more information about acupuncture, visit the National Center for Complementary and Alternative Medicine.
Acupuncture at SATU
SATU offers three regularly scheduled, one-hour acupuncture sessions each week. In addition, clinicians honor clients’ special requests for acupuncture. All SATU clinicians and senior staff are certified to provide acupuncture.
At SATU, where the goal is for all clients to be "drug free," maintenance drugs as a treatment intervention are not available. Clinicians work with clients to develop individualized recovery treatment plans. Acupuncture, Bryant explains, is an adjunct to treatment and never a stand-alone.
"It's very relaxing," says another SATU client. "It’s a good excuse to sit for an hour and not think about anything."
At some point in their daily lives, clients will experience the "stimulus" that might lead them to reach for a drug. "Acupuncture seems to widen their response time," Bryant observes, "allowing them to think first and realize they don't have to react to the stimulus. Instead they can use positive coping skills acquired in treatment."
Bringing Ear Acupuncture to Connecticut
In 1991, Bryant was trained in the auricular acupuncture protocol at the Lincoln Recovery Center in New York City. Dr. Michael O. Smith developed the protocol there in 1970 and used it to treat people with addictions. He has since worked tirelessly to train new providers and promote the efficacy of ear acupuncture around the world.
After her training, Bryant was one of a small team of clinicians who worked with the State of Connecticut to establish the Acupuncture Detox Specialist Law. This law allows people who are not nurses or physicians to become certified in auricular acupuncture for the treatment of addictions. The Connecticut law follows National Acupuncture Detoxification Association (NADA) protocol.
"The NADA 5-point protocol supports continued engagement in treatment," says Bryant. "Ultimately, that’s the most important thing."
It takes only a minute or two to insert the paper-thin needles into each ear. At SATU, clients then sit silently for thirty minutes or more in the soft, black chairs with matching footstools in the acupuncture room. The lights are dim. Most clients close their eyes; some fall into a meditative state that Bryant calls "needle sleep."
The five points are: (1) The Autonomic Point which calms the nervous system and helps with overall relaxation; (2) the Shen Men or "spirit gate," which reduces anxiety and nervousness; (3) the Kidney Point, for calming fears and healing internal organs; (4) the Liver Point for detoxification, blood purification, and to quell aggression; and (5) the Lung Point, which promotes aeration and helps clients let go of grief.
Clients are invited to have all five points or choose the ones they want that day. Pregnant clients receive only two points, the Shen Men and Lung.
This August, after water damage from Hurricane Irene temporarily relocated SATU to the main building of the Connecticut Mental Health Center, Bryant and her fellow clinicians set up shop on the Center's second floor. Along with SATU clients, thirteen CMHC staff members received auricular acupuncture that day. Michael J. Sernyak, MD, the Center’s CEO, participated for the first time. "I had this wonderful, contemplative time," he said afterward. "It was really unusual."
Clinicians, says Bryant, experience stress too; it's important that they develop ways to manage their stress. Acupuncture can help. The treatment is available to all CMHC staff members during any of SATU's regularly scheduled clinics.
SATU also welcomes CMHC clients with mental illness to the acupuncture clinic. "We just need to talk to the clinician to make sure they are psychiatrically stable and have no medical contraindications," Bryant explains. People with pacemakers cannot receive acupuncture; special considerations are given to those with certain medical conditions such as hemophilia and diabetes.
Training New Providers
In July 2009, for the first time, voluntary acupuncture training was offered to incoming addictions fellows and psychology interns from Yale University School of Medicine. Bryant led the training along with John Antonucci, MD of the Newington, Connecticut VA Medical Center. Every fellow in the addictions program participated.
Ismene Petrakis, MD, Chief of Psychiatry at the VA Connecticut Healthcare System, directs the world-renowned Yale Department of Psychiatry training program in addictions. She says medical students and practitioners have become increasingly interested in learning about alternative treatments and how they can be incorporated into medical practice.
According to Petrakis, research has shown that acupuncture is effective for addiction treatment. "The best evidence is when used as an adjunctive treatment for opioid detoxification," she explains. "I have encouraged the fellows and junior faculty to review the literature and decide for themselves how likely it is to be an effective treatment."
For Bryan Shelby, MD, the answer is very likely. Before becoming an addictions fellow, he had his own experience with acupuncture: after two treatments for carpal tunnel syndrome, his symptoms "pretty much went away." He completed an acupuncture program at Harvard Medical School and later trained with Katurah Bryant. As a fellow at the VA hospital, Shelby offered ear acupuncture to patients in the buprenorphine clinic. Buprenorphine (suboxone) is a maintenance drug for people recovering from opiate addictions. Acupuncture is used to help these patients reduce stress and anxiety.
"The vast majority of patients find it very relaxing," says Shelby. "It's impressive."
For Katurah Bryant, it's gratifying to train new providers every year. In addition to the Yale fellows, she has taught acupuncture to clinicians at New Haven's Cornell Scott-Hill Health Center and other places. But her greatest joy comes from helping patients.
"It's all about their recovery," she says, "and empowering them to make positive choices for their lives."