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L=#  376=K?+L7+J.£)­Acupuncture: The Value of the Non-Verbal
Michael O. Smith, MD, D. Ac
Acupuncture brings a non-verbal component to the addiction treatment process. Acupuncture does not
supplant the need for the counselor to talk with the patient, but allows the verbal interaction to be quite
flexible so that a patient who does not feel like talking can be accommodated easily and naturally.
Acupuncture will be just as effective even when the patient lies to us.
The most difficult paradox in the addiction medicine field is the common reality that addicted persons
usually deny their need for help. Such patients do not say anything helpful to the treatment process.
Nevertheless, resistant patients often find themselves in a treatment setting due to referral or otherpressures. Using acupuncture can bypass much of the verbal denial and resistance that otherwise limits
retention of new and relapsed patients.
Acupuncture treatment for drug and alcohol problems was primarily developed at Lincoln Hospital, a
New York City owned facility in the impoverished South Bronx. The Lincoln Recovery Center is astate-licensed treatment program that has provided more than 500,000 acupuncture treatments in thepast 20 years.
The Lincoln Hospital model can be summarized and defined as follows: 1) Clinicians use three to five ear
acupuncture points. 2) Treatment is provided in a group setting for a duration of 40 – 45 minutes. 3)
Acupuncture treatment is integrated with conventional elements of psycho-social rehabilitation. 4)
Several components of the Lincoln program are frequently combined with acupuncture in other treatment
facilities. These items include: a supportive non-confrontational approach to individual counseling; anemphasis on narcotics Anonymous and other 12 Step activities early in the treatment process; an absenceof screening for “appropriate” patients (so as to lessen unnecessary barriers); the use of herbal sleep mix;
the use of frequent urinalysis; a willingness to work with court-related agencies; and a tolerant, informalfamily-like atmosphere.
A wide range of patients can be accepted for the initial stage of treatment because there is no verbal
motivational requirement. Also, acupuncture is effective for most drugs and a wide range of psychologicalstates. Problems relating to language and cultural differences are diminished. For new patientsfrequent acupuncture treatment permits the gradual completion of assessment on a more accurate rather
than merely on the basis of the initial interview.
The tolerant, non-verbal aspect of acupuncture facilitates retention during periods when the patient
would otherwise be ambivalent, fearful, or resentful within a more intense verbal interpersonal setting.
The acupuncture makes it easy to provide outpatient treatment on demand, without appoints, while thepatients are being acclimated to the interpersonal treatment setting. Patients are often willing to beurine-tested even when they know that their toxicology result is positive, thereby showing respect for hevalue system of the overall treatment process. Those same patients may be unable or unwilling to share
their crisis and failure verbally until they have time to reach more solid ground. In the acupuncture
setting, time is on our side.
In practice, acupuncture provides an excellent foundation for 12 Step recovery. Patients seem lessfearful and more receptive when they first enter the meetings. The traditional advice: listen to learn
and learn to listen fits this model well. Acupuncture reduces white-knuckle sobriety considerably. There− 43 −

社会鍼灸学研究2011「災害と鍼灸」シンポジウム・記録集
is less guarding and greater ability to support each other warmly. The increased ability to use 12 step
meetings provides more stable support for continuing treatment on an outpatient basis.
Patients referred by court-related agencies often enter treatment in total denial or with a basic conflictwith the referring agency. The non-verbal aspect of acupuncture allows the intake staff to get beyond
these protests and offer acupuncture for stress relief, instead of forcing the issue. Using acupuncture weare able to wait until the patients feel more comfortable and less threatened so they can admit theiraddiction and ask for help.
The nature of recovery form addiction is that patients often have quickly changing needs for crisis relief
and wellness treatment. May persons in recovery have relatively high levels of wellness functioning.
Even so, a crisis of craving or past association may reappear at any time. Acupuncture provides either
crisis or wellness treatment using the same ear point formula. The non-verbal, present-time aspects ofthe treatment make it easy to respond to a patient in whatever stage of crisis or denial that may exist.
Addiction patients often can’t tolerate intense interpersonal relationship. Using a conventional
one-to-one approach often creates a brittle therapeutic connection. It is easily broken by events or any
stress. Patients have difficulty trusting a counselors words when they can hardly trust themselves.
Even after confiding to a counselor during an intake session, a patient may feel frightened and confused
about expanding that relationship. Many of their concerns are so complex and troublesome that talking
honestly about their lives could be difficult in the best of circumstances. The ambivalence typical of
addicts makes it easy to develop misunderstandings. All of these factors support the usefulness of
non=verbal; technique during early and critical relapse phases of treatment and critical periods of relapse.
A woman six months pregnant entered our clinic several years ago. She said, “I can’t tell you muchabout myself because my husband is out in the street with a baseball bat, he’ll hit me in my knees if I say
too much.” We provided an emergency acupuncture treatment and conducted a simplified intake
interview. Two weeks later this patient told us, “This is my husband, he doesn’t have a drug problem, but
he is nervous, can you help him?” Both of them received acupuncture that day. The woman needed
on-verbal access to treatment because of real physical danger. Overprotective spouses often forcefully
oppose all social contacts outside the marriage. This patient was protected because there was nopremature verbal bonding that would have threatened the husband. The whole process was so supportivethat the husband was able to trust his wife and seek help himself. Like many fearful people, he wasliterally unable to make any verbal approach on his own.
Treatment programs without acupuncture are compelled to screen for patients who are able to talkreadily with authority figures. Many verbally needy patients become quite dependent on the programand quite involved with numerous staff members. Such patients may be the focus of many conferences,
but they are often too needy to remain drug-free outside the treatment setting.
In contrast,
acupuncture-assisted intake can retain patients who re relatively more paranoid, independent, assertiveand hostile. Noisy, troublesome patients who are frustrated with the world and with themselves actually
may be more likely to sustain a drug-free lifestyle than patients with verbal dependency needs.
Acupuncture helps a program develop an underlying environment of acceptance, tolerance and patience.
There is ample space for the ambivalence and temporary setbacks that are a necessary part of any
transformation. Patients can have a quiet day by attending the program and receiving acupuncture
without having to discuss their status with a therapeutic authority figure. Since acupuncture reduces theagitated defensive tone in the whole clinical environment, patients are able to interact with each other on amuch more comfortable level. Their increased ability to listen to others and accept internal changes havea profound effect on the quality and depth of communication in group therapy session and 12 Step
meetings.
M Smith, a psychiatrist, is director of the Lincoln Recovery Center in Bronx, NY. He was a co-founder of
the NADA and is a frequent speaker and consultant for addiction treatment programs throughout the US
and many foreign countries.

− 44 −

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− 45 −

社会鍼灸学研究2011「災害と鍼灸」シンポジウム・記録集
Ear Acupuncture Protocol Meets Global Needs
Michael O. Smith, MD
More than 2000 drug and alcohol treatment programs in the US and forty other countries have added an
acupuncture component to their protocol during the past several years. This development is based on the
30-year experience of Lincoln Hospital (Bronx, NY) which provides 100 acupuncture treatments per day spart of its comprehensive program. The nationally recognized Miami Drug Court model is an outgrowthof the Lincoln experience. Basic controlled studies will be presented as well as outcome evaluations basedon various clinical situations. Dr. Yoshiaki Omura helped develop this program.
Acupuncture provides a foundation for psycho-social rehabilitation. It is only an adjunctive, supportive
component of substance abuse treatment. Several characteristics enhnace the benefits of acupuncture on
overall program functioning: 1) it’s a nonverbal component which facilities access to resistant patients; 2)
it reduces level of anxiety and agitaiton program – wide; 3) it facilitates calm, receptive behavior; 4) ithelps developed the inner meditative core of even trouble fearful persons. This same acupuncture
protocol has been adopted for use in more than 50 large psychiatric hospitals in Germay and Scandinavia.
These hospitals have trained more than 50 nurses in each of their facilities. They report much less use of
seclusion and benzodiazepines.
Acupuncture has been used to treat thousands of post-traumatic patients in lower Manhattanin 2001
and New Orleans in 2005. Treatment of fire men, police officiers, and stressed healthcare workers has
been so successful that there is an effort to train trauma first responders to provide treatment. During
the recent hurricane season the medical board and state legislation of Louisiana have announced a newacupuncture law which allows a large number of people to be approved to use NADA acupuncture undergeneral supervision.
Acupuncture is regularly used with other medications, including methadone, antidepresants, andneuroleptics. Manetic beads (acupressure) have been shown to be effective in children with attention
deficit, hyperactivity, and borderline autism.
The Lincoln Hospital acupuncture program has led to the establishment of the National Acupuncture
Detoxification Association (NADA). NADA has established standards for training and certification of“acupuncture detoxification specialists” on a widespread basis. According to New York State law, forinstance, any clinician in an approved treatment setting can complete the 70-hour training program and beable to provide ear acupuncture under general supervision of a licensed acupuncturist. This law has
allowed acupuncture to be part of more than 200 treatment programs in the state.
Refugee services in war-torn areas hae been particularly impressie. The DARE program in Thailand
has provided ear acupuncture for many years with a dozen different Burmese tribes in border camps.
NADA was introduced during a 2 week training in refugee campsin East Africa in May 2008. By the endof a year, 29,000 treatment were provided by the refugee trainees. Support was provided for survivors ofa violent land dispute, and for the soldiers guarding them.
NADA members have used magnetic beads to treat children with attention-deficiet/hyperactivity
disorder (ADHA), autism-spectrum disorders, night tremors, bedwetting, and violence-prone adolescents.
The beads are placed on the back of the ear opposite the Shenmen point. Beads remain in place with anadhesive 1-2 weeks at a time. Many instance of prolonged improvement have occurred, but this techniqe
is only in an early stage of evaluation.

− 46 −

社会鍼灸学研究

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社会鍼灸学研究%°±)çáÙ('7ċ7%* çá2011「災害と鍼灸」シンポジウム・記録集

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− 49 −

ëùöÂÅàyćÓßãyxõåā¸社会鍼灸学研究2011

「災害と鍼灸」シンポジウム・記録集

Unimagined Bridges

Directed and Produced: Laura Cooley, NADA Registered Trainer
http://www.malula.net/index.html
M S: After the WTC attacks the therapist were nervous, the patients were frightened
and nervous and didn’t know what to say either. So very few people were interested inverbal therapy very few.
JS: Saint Vincent’s is the closest major trauma unit to ground zero. I was assigned to a
sub acute ER in the hospital and we had all this equipment but very few patientscoming through. It was really a firefighter who was in the sub acute ER who was so
distraught looking ask him if he had anything he wanted to say, and he didn’t.

A New Approach to Disaster

SM : One of the concerns in the trauma field is how to help people who actually avoid
treatment and one of the things we had to try and figure out is why their avoiding
treatment. And it became clear that the major reason is that this is the group thatre-experiences the trauma by even talking about what happened. So the last place
their goanna wanna go is talking to a therapist.
JS: I was a psychiatric nurse; I was seeing what we really needed to be doing.
Something different and I did get permission from the medical director that evening tostart ear acupuncture the next day. We were very busy; there were days that we wereseeing up to 100 people. The counseling unit was next to the ear acupuncture clinic andthey were seeing far fewer numbers of people. I think that is indicative to what people
were looking for but we’re filling their need they wanna talk.
M S: This was able to help people without having to explore something that requires
verbal trust, appropriate language and a perspective to describe things that people
didn’t have and that was the problem. In trauma situations you don’t have trust.
Western mental health doesn’t work unless you have trust you don’t have prospective;
you don’t always have the language. Lets say you’re not only traumatized but yourlanguage is different than the dominant language. Why on earth should you be able todiscuss this, further more how many therapist do we have that are so good that they
can work with you and whatever sub group you belong to on the spur of the moment
without any money in the middle of nowhere and why should that be the case.
We simply put up signs that said stress reduction clinic and in parenthesis said ear
acupuncture. And what was interesting was that many people came never having
heard of ear acupuncture or understanding anything about why they would be coming
for ear acupuncture but it was clear to everybody why you might go to a stress
reduction clinic and it turned out to be very popular not only with the staff but thepeople in the community.
RD: The object of the game for me and the people that I work with is to reduce stressfor firefighters. And we found that a very simple way to do that was acupuncture.
JS: At the hospital we already had ear acupuncture available for our clients in the
addiction program. So it was just a matter of transferring that to people who would be
experiencing traumatic symptoms after a huge disaster such as 911.
M S: I have been a psychiatrist at Lincoln since 1969. We were always a little
frustrated with the effects of methadone. And so in 1974, we read in the newspaperthat acupuncture had been used by Dr Wen in Hong Kong to help heroin addicts.
Pretty soon we realized that we could actually run the entire program based on
acupuncture not methadone. So that they could participate in groups and otheractivities.
JS: We followed a protocol that was set up by NADA. A simple protocol of 5
acupuncture points on the ear referred to as the NADA 5pt protocol has been found tobe effective without side effects and easily taught to those providing services in thehealth care setting. French, German and Chinese identified acupuncture points on the− 50 −

社会鍼灸学研究2011

「災害と鍼灸」シンポジウム・記録集

ear that correspond to all the different parts of the body. These points havedemonstrated therapeutic effects on mental, emotional and physical states of being.
M S: When acupuncture started to be used after the 911 attack for instance we had
always talked about it previously as being related to an addiction problem because wereally didn’t have any venue to learn how it might be relatable.
SM : Can help both acute anxiety and insomnia without using sedatives and allow
someone to integrate what’s going on in a natural way.
RD: Drove home to Long Island, driving home I thought I really don’t feel any
difference and when I got home I had dinner and I thought I still don’t feel any
difference and then it showed up later on that week. I slept 5 nights, it was the first 5nights sleep I had since September 10th 2001 so theirs no question in my mind that thisis good stuff. I have no clue I don’t know how it works I have no vague idea how it
works it’s not important to me to find that out. I just know this is what it did for me.
SM : One of the advantages of the ear acupuncture in our setting was that it was done
at a community hospital in a large open setting and that’s very helpful. It’s not done ina quiet room you don’t know what the therapist is gonna do. Saint Vincent’s was wellknown to the people who live in the area and the fact that they were offering stress
reduction in a non-medical setting drew a lot of people who weren’t interested in either
psychotherapy or medication.
JS: The WTC healing services was created after September 11th to meet the needs ofthe downtown community. The name of the clinic is the Integrated Stress Management
Program. In addition to the ear acupuncture, the other modalities that we offer areenergy work like Reiki and reconnected Jo-Re energy work, massage. We offer soundhealing, Ruth Cunningham is a sound healing practitioner and she plays the harp, theflute and she uses her voice to create beautiful relaxing sounds.
We have a suite of offices downtown a block from ground zero. And 2 afternoons a
week around lunchtime we offer ear acupuncture to people in the financial district whoare still dealing with the aftermath Sept 11.
And they come in to receive ear acupuncture and counseling and if they don’t want todeal with counseling they don’t have to. In the meantime, we can provide themsomething like ear acupuncture. We also have 4 clinics in the high schools that boarder
around ground zero, so we are able to go in and provide ear acupuncture services to theemployee’s particularly the teachers who dealt with a lot during that period after 911.
In addition, after the Staten Island Ferry accident, we were able to start a clinic at
Saint Vincent’s in Staten Island.

China Town.

FW : We were hoping at Saint Vincent’s that we could combine eastern practices withwestern holistic healing. People in the Chinese community feel like they know ear
acupuncture. I’m sorry not ear acupuncture but acupuncture which has been in our
culture for thousands of years There are a whole bunch of people who haven’t had
acupuncture but are open to the idea of having it because it’s familiar. We came to theAmerican Legion, some of the veterans still had PTSD and they are still having
nightmares now and these are people who are in their 60’s or 70’s. So we wanted toreach out and service this population.
HPC: I’m officer Chan with NYC Dept of Corr, as a correction officer we work inside
detention in jail and the stress level in there is tremendously high and we have to deal
with situations of life and death all the time. And by utilizing ear acupuncture actually
helps me decrease my anxiety and stress level from day to day operations inside thejail. It’s using their own healing methods so they’re proud to come for ear acupuncture
because this is my culture.
JS：In the fall of 2005, staff from the hospital was sent down to central Louisiana andit worked really nicely with the medical team, the evacuee’s in parking lots who wereseeing medical teams for physical problems. Some of them were getting ear− 51 −

社会鍼灸学研究2011

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acupuncture in sorta our parking lot waiting area before they saw a doctor. It wasgood.
SM : One important thing after a crisis of any nature is to be able to calm down enoughto sleep. We’ve always known in psychiatry that 3 or 4 days of no sleep, everyone is at
risk of acute psychosis. We did questionnaire early on like what brought you here,
what did you experience. It was just sort of basic feedback the overriding comments
were that people felt calmer and more able to cope and you think about it that really is
the goal and it’s both in those things not just being calmer. If the goal were just to becalmer sedatives would be useful.
But we know sedatives are not useful because people don’t feel increasing prepared
to cope. It diminishes their ability to cope and reintegrate what’s going on. So theirs
something probably unique about ear acupuncture and other mind body interventions.
That what their really doing is balancing both the ability to be calm and yet alert andprepared. In Chinese medicine, one of the ways I’ve heard it spoken is that after crisis
chi scatters, and one questions how do you help the chi re-establish itself and I thinkthat is what we call regulation, affect and mood and modulation.
All these kind of terms it’s really sorta where the future of psychiatry is going is how
do you know people modulate. Medications are easier. Being able to take a medication
daily that does help modulation affect is very useful but medicines are very expensive,
and a lot of people are not interested in medications. You have to have tools that arereadily available.
M S: The good thing about this system is that not only is it easy to use but easy toteach people how to do this of all the things your gonna teach people in crisis, this is
close to the safest you could possibly do.
RD: It’s interesting because now I’m just starting to work with a couple of fire deptclinicians on programs for returning veterans from Iraq and the more we work the
program the more I see an opportunity for us to use acupuncture for some of these guys
to reduce the stress that that have.
SM : Trauma happens all over and you can’t possibly have extensive trauma help
intervene something like ear acupuncture so simple and so inexpensive can travel
where the trauma occurs. St Vincent’s ended up with dialogue with the Red Cross
partly because how many clients we were serving in the ear acupuncture clinic. I thinkthat the ear acupuncture actually could have a major role in preventive medical health.
One of the things that we know that cardiologist talk about stress impacts cardiac
health like hypertension, high cholesterol heart disease basically. So if you have asimple tool that actually helps stress reduction why not use it for medical complement.

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