In the UK, the prevalence of substance misuse is around 9 per 1,000 of the population aged 15-64 years, and around 3 per 1,000 inject drugs, in most cases opioids (NICE 2007). In 2005/6, around 181,000 people were using drug treatment services in England and Wales (Commission for Healthcare Audit and Inspection 2006). Also, research in England in 2005 estimated that 7.1 million people, or 23% of the adult population, could be categorised as hazardous or harmful alcohol users (Drummond 2005). Indeed, in England, 150,000 hospital admissions annually result from acute or chronic alcohol use, and alcohol use is implicated in 33,000 deaths each year (Academy of Medical Sciences 2004).
Dependence on drugs is a cluster of physiological, behavioural, and cognitive phenomena in which the use of a substance takes on a much higher priority for a given individual than other behaviours that once had a greater value (WHO 2007). Drugs of abuse include cannabis, opioids (opiates), CNS stimulants (cocaine, crack, amphetamines, ecstasy, crack), CNS depressants (barbiturates, benzodiazepines, alcohol), hallucinogens (LSD, psilocybin), and volatile substances (glues, gases, aerosols) (DTB 1997).
Opioid misuse and dependence are associated with a wide range of problems, such as overdose; infection with HIV, hepatitis B or hepatitis C; thrombosis; anaemia; poor nutrition; dental disease; criminal behaviour; relationship breakdown; lost productivity; unemployment; imprisonment; social exclusion; and prostitution, as well as withdrawal symptoms (Prodigy 2006; Gowing 2006; National Treatment Agency for Substance Misuse 2006). Problems associated with excessive alcohol use include hypertension, accidental injury, hand tremors, duodenal ulcers, gastrointestinal bleeding, cognitive impairments, anxiety and depression (Saunders 1990). The development of alcohol dependence appears to involve changes in brain neurotransmission (Littleton 1994; Tsai 1995).
Treatment programmes to help people with drug and alcohol problems include a range of individualised psychosocial interventions such as counselling, self-help groups, and rehabilitation programmes, in addition to medication.
Academy of Medical Sciences. Calling time: the nation's drinking as a major health issue. London: AMS, 2004.
Commission for Healthcare Audit and Inspection, 2006. Improving services for substance misuse. A joint review [online]. Available: http://www.healthcarecommission.org.uk/_db/_documents/improving_services_for_substance_misuse.pdf
Drummond C et al. Alcohol needs assessment research project. London: Department of Health, 2005.
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Littleton J, Little H. Current concepts of ethanol dependence. Addiction 1994; 89: 1397-412.
National Institute for Health and Clinical Excellence, 2007. Technology Appraisal Guidance 114. Methadone and buprenorphine for the management of opioid dependence [online]. Available: http://www.nice.org.uk/guidance/TA114/guidance/pdf/English/download.dspx.
National Treatment Agency for Substance Misuse, 2006. Models of care for treatment of adult drug misusers: update 2006 [online]. Available: www.nta.nhs.uk/publications/mocpubs.htm
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How acupuncture can help
Acupuncture is used extensively, and worldwide, in substance misuse treatment centres. This stems from the development of a simple 5-point auricular acupuncture protocol at New York's Lincoln Hospital in the 1970's, originally for drug users but subsequently extended to tobacco, alcohol and other addictive substances and behaviours. The protocol was designed to operate within Western health settings and mutual peer support systems, not as an isolated treatment.
In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the 'analytical' brain, which is responsible for anxiety and worry (Wu 1999).
Results from randomised controlled trials (Tian 2006; Berman 2001; Hyun 2010; Yeh 2009; Wu 2007) and systematic reviews (Cho 2009; Liu 2009; Gates 2006; White 2006; Jordan 2006; Mills 2005) looking at the effects of acupuncture on withdrawal symptoms and relapse rates related to alcohol, opiate, nicotine and cocaine misuse have been equivocal, mainly because of the poor quality of the research. The acupuncture provided in the trials has sometimes been inadequate, sham controls have often been inappropriate, many studies are too small and high dropout rates are common. Acupuncture has most commonly been evaluated against a sham control, which may in effect be no more than comparing two versions of acupuncture. There appears to be a discrepancy between results in experimental settings and those in normal practice, so context effects may be important (Margolin 2003). Better studies are required, especially those comparing acupuncture to usual care, and as an adjunct to usual care rather than a stand-alone intervention (See Table below).
Acupuncture may help relieve symptoms of drug withdrawal by:
- normalising the release of dopamine in the mesolimbic system. This reduces the over-stimulating effects of abused drugs and modifies behaviours associated with addiction such as those around desire and reward. Several brain neurotransmitter systems, for example serotonin, opioid and GABA, are implicated in this (Lee 2009a, Yang 2008, Zhao 2006)
- reducing anxiety (Samuels 2008). Acupuncture can alter the brain's mood chemistry, reducing serotonin levels (Zhou 2008) and increasing endorphins (Han 2004) and neuropeptide Y levels (Lee 2009b; Cheng 2009);
- modulating postsynaptic neuronal activity in the nucleus accumbens and the striatum to reduce nicotine addiction (Chae 2004) and increasing corticotrophin-releasing factor to attenuate anxiety-like behaviour following nicotine withdrawal (Chae 2008);