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The Integrated Approach to Treating Addiction

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... and advocated by the National Acupuncture Detoxification Association (NADA) ... NADA Protocol. 5 Points for Addiction. Sympathetic. Shen Men (Spirit Gate) ... – PowerPoint PPT presentation

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Title: The Integrated Approach to Treating Addiction


1
The Integrated Approach to Treating Addiction
  • Andrea Pennington, M.D., C.Ac.
  • Andrea_at_PenningtonInstitute.com

2
The Integrated Approach to Treating Addiction
  • Acupuncture
  • Mind-Body Therapies
  • Herbal Remedies
  • Somatic Psychotherapy

3
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).

4
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.

5
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.
6
Effects of Acupuncture onAddiction
  • Decreases cravings
  • Improves sleep patterns
  • Reduces anxiety
  • Aids in stress reduction
  • Improves participation in counseling process

7
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
8
Auriculotherapy
  • Ear is a microsystem of the body

9
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
10
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.
11
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.
12
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.
13
Acupuncture and stress management
  • Decreased sensation of distressful fight or
    flight response
  • Reduced cortisol levels
  • Decreased impulsivity

14
Mind-Body Therapies
  • Meditation
  • EMDR
  • Biofeedback
  • Neurofeedback
  • Guided Imagery
  • Hypnosis
  • Yoga
  • Therapeutic Massage
  • Somatic Psychotherapies

www.emdr.com www.ronkurtz.com/writings.html
15
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..

16
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.

17
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
18
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
19
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

20
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

21
Responses to Trauma - Emotional
  • Depression or sadness
  • Irritability, anger, resentfulness
  • Despair, hopelessness, feelings of guilt
  • Phobias, health concerns
  • Anxiety or fearfulness

22
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

23
Responses to Trauma - Physical
  • Post Traumatic Stress Disorder
  • Exacerbation of medical problems
  • Headaches
  • Fatigue
  • Physical complaints with no physical cause

24
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.

25
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.

26
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

27
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).

28
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).

29
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).

30
Cultural Differences in Response to Trauma
  • Universal response is toward forming attachments
    and building community
  • US Open discussion and expression

31
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

32
Cultural Differences in Response to Trauma Asian
Americans
  • Japanese Passive dependency
  • Helplessness
  • Insecurity
  • Chinese Somatopsychic expressions
  • Headache
  • Weakness
  • Irritability
  • Poor appetite

33
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

34
Cultural Differences in Response to Trauma
Latinos/Hispanics
  • Desire to conform to culture of US
  • Victims may try to blend in, avoid standing out

35
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
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