Behavioral Health Is Essential To Health • Prevention Works • Treatment Is Effective • People Recover

ADVISORY

Fall 2015 • Volume 14 • Issue 2

Complementary Health Approaches: 

Advising Clients About Evidence and Risks

Many clients receiving conventional evidencebased treatment for mental or substance use 

disorders may also try various nonmainstream, or 

complementary, health approaches to treat their 

disorders or to relieve symptoms; some may do 

so without professional guidance. Clients may 

also independently turn to complementary products or practices to address co-occurring medical 

issues such as pain or to achieve personal health 

and wellness goals such as weight loss. At the same 

time, an increasing number of medical facilities 

and behavioral health programs are including 

complementary health approaches in their menu 

of services.

Complementary therapies vary in their safety, 

cost, and evidence of effectiveness. Clients may 

spend a great deal of time and money on products 

and services without knowing whether or how 

they work. In addition, clients may be unaware 

that some complementary therapies can have side 

effects or adversely interact with medications. 

Some clients may not tell their behavioral 

health service practitioners of their use of 

complementary therapies; other clients may 

ask practitioners whether complementary 

health approaches are helpful. Practitioners 

may also be called on to explain the benefits 

of any complementary practices offered by 

their treatment programs. This Advisory gives 

behavioral health service practitioners a brief 

overview of complementary health approaches 

and information on efficacy and cautions so that 

they can talk knowledgeably with clients and 

offer appropriate guidance.

What Are Complementary Health 

Approaches?

The term complementary health approaches

encompasses a group of diverse medical and 

healthcare systems, practices, and products that 

are not generally considered to be part of conventional medicine.

1

 Also called “mainstream,” 

“modern,” or “Western” medicine, conventional 

medicine is practiced by doctors holding medical 

degrees and by allied health professionals, and its 

practices are evaluated scientifically for evidence 

of effectiveness.

Most Americans use nonmainstream practices 

as complements, rather than as alternatives, 

to conventional medicine.1

 Generally speaking, 

complementary therapies have not been evaluated 

as extensively and rigorously as practices in 

conventional medicine.

Many complementary therapies have emerged out 

of ancient medical systems, such as Ayurvedic 

medicine from India, traditional Chinese medicine 

(which includes acupuncture), traditional African 

medicine, shamanism, and Native American 

healing practices. Other systems that offer complementary therapies, such as homeopathy and 

naturopathy, stem from practices that emerged in 

Europe beginning in the late 18th century. (See 

Exhibit 1.)

An increasing number of medical care and 

behavioral health facilities now offer integrative 

health (also known as integrative medicine), 

which combines complementary practices with 
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conventional treatment plans. More than 60 academic 

health centers and affiliate institutions in the United 

States, Canada, and Mexico are members of the 

Academic Consortium for Integrative Medicine and 

Health and include complementary health approaches 

in their curricula. According to the Consortium, integrative medicine and health “reaffirms the importance 

of the relationship between practitioner and patient, 

focuses on the whole person, is informed by evidence, 

and makes use of all appropriate therapeutic and 

lifestyle approaches, healthcare professionals and 

disciplines to achieve optimal health and healing.”5

Development of scientific evidence in the field of 

complementary and integrative medicine has been 

advanced by the National Institutes of Health’s 

National Center for Complementary and Integrative 

Health,* which funds and conducts research and 

provides information for consumers and practitioners. 

Some complementary therapies are now covered by 

health insurance or other reimbursement systems.

* On December 16, 2014, legislation was enacted that changed the name of the National Center for Complementary and Alternative Medicine to the National Center 

for Complementary and Integrative Health.

Exhibit 1. Examples of Nonconventional Medical Systems2, 3, 4

Ayurvedic medicine: a system of traditional Indian medicine that aims to integrate and balance the body, mind, 

and spirit. Ayurvedic practices aim to cleanse the body of substances that can cause disease, and this is believed 

to help reestablish harmony and balance. Ayurvedic remedies are often herbally based.

Homeopathy: a system of medical practice based on the theory that any substance that can produce disease 

symptoms in a healthy person can cure those symptoms in a sick person. For example, someone suffering from 

insomnia may receive a homeopathic dose of coffee. Ingredients for homeopathic remedies are derived from 

plants, minerals, or animals. Typically, the ingredient is highly diluted, and other active ingredients may be included 

in the mixture.

Naturopathy: an alternative medical system that proposes that a healing power in the body establishes, 

maintains, and restores health. Practitioners work with patients to support this power through nutrition and lifestyle 

counseling, dietary supplements, medicinal plants, exercise, homeopathy, and treatments from traditional Chinese 

medicine.

What Types of Practices and 

Products Are Considered 

Complementary?

A variety of health practices and products can be 

included under the label complementary.

Manipulative and body-based therapies

The category of manipulative and body-based therapies 

includes interventions that a trained practitioner performs on the client. It also includes therapies in which 

the client receives training in certain movements and 

exercises designed to address overall mental, spiritual, 

and physical health. (See Exhibit 2.) In the United 

States, practitioners of manipulative and body-based 

therapies typically receive formal training and obtain 

certification granted by a licensing board or a related 

professional organization.

Mind and body medicine

Interventions that seek to harness the power of the 

mind to make positive health changes are included in 

the category of mind and body medicine. (See Exhibit 

3.) Some of these therapies are based on the idea that 

the body has energy fields that can be manipulated for 

health through the use of light, magnets, or touch.
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Exhibit 2. Examples of Manipulative and Body-Based Therapies2

Acupuncture: from traditional Chinese medicine, a system of procedures involving stimulation of anatomical 

points on the body to treat various physical, mental, and emotional conditions. The practitioner pierces the 

patient’s skin with thin metallic needles to adjust the flow of energy (qi) through the body. Other variants of 

acupuncture use heat, electricity, lasers, or pressure.

Alexander technique: a movement therapy that seeks to improve posture and movement by teaching a person 

more efficient use of muscles to enhance the body’s overall functioning.

Chiropractic care: a form of health care that emphasizes adjusting the spine and joints to influence the body’s 

nervous system and natural defense mechanisms to alleviate pain and improve general health. Doctors of 

chiropractic, also called chiropractors, use this hands-on therapy (called manipulation or adjustment) as their main 

clinical procedure.

Massage: manipulation of muscle and connective tissue to enhance function of those tissues and promote 

relaxation and feelings of well-being.

Osteopathy: a full-body system of hands-on techniques to alleviate pain, restore function, and promote health 

and well-being. In the United States, osteopathic physicians practice modern medicine in addition to performing 

manual osteopathic techniques.

Pilates: movement therapy that uses physical exercise to strengthen and build control of muscles, especially 

those used for posture. Awareness of breathing and precise control of movements are integral components. 

Special equipment is often used.

Natural products

Natural products include vitamins; minerals; 

botanicals (herbs, seeds, and other plant products); 

probiotics (live microorganisms similar to beneficial 

microorganisms found in the human gut); amino 

acids; and other substances found in the human diet, 

such as enzymes. Typically, natural products are 

taken orally in the form of a pill, capsule, tablet, or 

liquid (such as in a tea or tincture). They may also be 

applied topically and absorbed through the skin (such 

as with a poultice or cream).

Many natural products are aggressively marketed and 

are widely available to the public without prescription 

at grocery stores, health food and nutrition stores, and 

drug stores and through the Internet. Some natural 

products (such as chamomile for tea and turmeric 

used as a seasoning) may also be cultivated and 

grown at home.

Under federal law, if a product is promoted as intended 

to diagnose, treat, prevent, or cure any disease, it is 

considered a drug; a natural product promoted without such claims may be marketed as a dietary supplement. The Food and Drug Administration (FDA) does 

not approve dietary supplements for safety (except 

when a supplement contains a new dietary ingredient 

not previously approved) and effectiveness, as it does 

for prescription and over-the-counter medications. 

However, FDA does monitor the labeling claims 

made on dietary supplements, and the Federal Trade 

Commission monitors the advertising claims.6

 Despite 

this monitoring, product promotions for dietary 

supplements may imply benefits that cannot be explicitly stated without the product being categorized as a 

drug.

Because federal law does not require standardization 

of dietary supplements, products of the same type 
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differ in terms of ingredient combinations, amounts, 

and potency. Manufacturers must follow FDA’s 

Current Good Manufacturing Practices for dietary 

supplements, which require that dietary supplements 

be accurately labeled and produced in a manner such 

that they meet the manufacturer’s specifications 

regarding the identity, purity, strength, and composition of the ingredients used.7

 However, no regulatory 

agency tests dietary supplements to ensure that 

they contain only the ingredients claimed and that 

ingredient amounts are accurate as stated.

Exhibit 3. Examples of Mind and Body Medicine2

Biofeedback: a method using electronic devices to teach clients how to improve health by consciously regulating 

breathing, heart rate, blood pressure, and other bodily functions.

Deep breathing: slow and deep inhalation and exhalation through the nose. Attributed benefits include release of 

tension, pain relief, and better organ function.

Energy healing therapy: the channeling of what is believed to be healing energy through the hands of a 

practitioner into a person’s body to restore a normal energy balance and, therefore, health.

Guided imagery: relaxation techniques using visualization of calm and peaceful images. An individual receiving 

guided imagery treatment will visualize his or her body free of a specific problem or condition.

Hypnotherapy: a procedure aimed at producing an altered state of consciousness characterized by increased 

responsiveness to suggestion. Objectives vary but include reducing anxiety, relieving pain, and improving sleep.

Meditation: a variety of techniques that discipline the mind to promote relaxation, generate energy, and improve 

other-oriented traits such as compassion and generosity. Meditation is rooted in Eastern religions, but it does not 

conflict with other religious or cultural practices. Mindfulness meditation involves a focus on the present moment, 

with a nonjudging acceptance of thoughts and feelings as they occur.

Progressive relaxation: a technique used to relieve tension and stress by systematically tensing and relaxing 

muscle groups.

Qi gong: an ancient Chinese discipline combining the use of gentle physical movements, mental focus, and deep 

breathing. In addition to improving physical health, qi gong is intended to provide benefits such as reductions in 

stress, pain, and depression.

Reiki: an energy healing therapy that originated in Japan. The practitioner places his or her hands on or near the 

person receiving treatment, with the intent to transmit ki, believed to be life-force energy.

Tai chi: a Chinese mind and body practice in which the body moves slowly and gently through a series of poses. 

It is believed that tai chi helps the qi, the vital energy, flow through the body. Tai chi is sometimes called moving 

meditation.

How Popular Are Complementary 

Health Approaches?

The 2012 National Health Interview Survey (NHIS) 

found that a third of adults in the United States had 

used some type of complementary practice or product 

in the 12 months before the survey.8

 This level of 

use is consistent with levels reported in the surveys 

conducted in 2002 and 2007.8 According to the 2012 

NHIS, the complementary health approaches most 

commonly used by American adults are nonvitamin/

nonmineral dietary supplements (17.7 percent); deep 

breathing (10.9 percent); yoga, tai chi, or qi gong 

(10.1 percent); chiropractic or osteopathic care (8.4 

percent); meditation (8.0 percent); and massage 

therapy (6.9 percent). According to the 2007 NHIS, 

the most common reason for accessing complementary 

health approaches is for pain relief (e.g., back, neck, 

joint).2

In 2007, Americans spent $33.9 billion out of pocket 

for complementary therapies.9 A large portion of this 
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amount was for products, classes, and materials not 

specifically recommended by a healthcare provider or 

complementary health practitioner.1

How Popular Are Complementary 

Health Approaches for Treatment 

of Mental or Substance Use 

Disorders?

The 2007 NHIS found that 45.4 percent of adults who 

were current moderate or heavier drinkers* had used 

complementary health approaches in the preceding 12 

months (reasons unspecified). The survey also found 

that in the preceding 12 months, 2.8 percent of adults 

had used complementary health approaches for anxiety, and 1.2 percent had used complementary health 

approaches for depression.2

* Current moderate or heavier drinker—Adults who, on average, consumed more than 3 drinks per week up to 14 drinks per week for men and more than 3 drinks per 

week up to 7 drinks per week for women were moderate drinkers. Adults who, on average, consumed more than 14 drinks per week for men and more than 7 drinks per 

week for women were heavier drinkers. To be considered a current moderate or heavier drinker, the survey participant had to have consumed at least 12 drinks in his or 

her lifetime.2

A 2005 study of data from the National Comorbidity 

Survey Replication determined that 6.8 percent of 

participants with a mental or substance use disorder** 

had used a complementary therapy (alone or with 

treatment from another source) to treat the disorder 

in the 12 months before the survey interview.10 The 

study also found that, in the same 12-month period, 

31.3 percent of all mental health visits were to 

complementary health practitioners.10

** Mental disorders included anxiety, impulse control, and mood disorders.

What Is the Appeal of 

Complementary Health 

Approaches for Behavioral 

Health Treatment?

For a variety of reasons, complementary health 

approaches can be especially appealing to behavioral 

health clients. Individuals who have not been successful with a particular conventional treatment may 

be curious about trying complementary therapies as 

adjuncts or treatment alternatives. Or, such individuals may hope that augmenting conventional treatment 

will enhance their recovery. Some clients may have a 

lifestyle preference for products and healing systems 

they perceive as natural, want to avoid medication 

side effects, or appreciate the hands-on care they 

receive from a complementary health practitioner.

From the standpoint of the behavioral health treatment 

program, offering a complementary therapy that is 

culturally relevant or popular in the community may 

attract prospective clients to the program’s conventional treatment offerings and support retention. Some 

practices, such as meditation or movement-based 

therapies, may help clients gain self-efficacy skills. 

Complementary practices offered to groups may 

also enhance clients’ socialization skills and support 

systems.

How Effective Are Complementary 

Health Approaches?

Complementary health approaches have been 

insufficiently studied compared with conventional 

treatments. Many of the studies that have been conducted lack one or more features of the randomized 

controlled trial (RCT), which is the gold standard for 

evaluating biomedical or behavioral interventions. 

An RCT compares a treatment with a different treatment or with a placebo and randomly assigns subjects 

to experimental and control (comparison) groups. 

RCTs are often blinded (that is, the subjects or the 

scientists administering the experiment, or both, do 

not know which treatment each subject is receiving) 

and, ideally, include sample sizes large enough for 

study results to achieve statistical significance. A 

well-designed RCT seeks to account for all possible 

variables that may influence the study results.
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These features of the RCT can present challenges 

when assessing complementary practices. For example, some complementary practices involve multiple 

components (e.g., movement combined with meditation and deep breathing); teasing apart the effects 

of each component adds to the already considerable 

amount of time, funds, and labor required to conduct 

an RCT. Also, when studying interventions such as 

yoga or acupuncture, it is often not feasible to blind 

study participants and those administering the intervention. Yet another challenge is that complementary 

health practitioners typically customize the treatment 

to the individual. For purposes of an RCT, however, 

the intervention must be standardized, which can 

make a study’s results less relevant to real-world 

application. The challenges of evaluating complementary health approaches through well-designed 

RCTs are prompting health researchers to explore 

alternative trial designs.11

Another challenge in evaluating the efficacy of 

complementary health approaches is the ongoing 

debate over the value of the placebo effect. Evidence 

on a variety of complementary practices indicates 

that positive effects that occur may be attributable 

not to the treatment itself, but rather to the interaction between the complementary health practitioner 

and the patient, the patient’s beliefs and expectations 

about the treatment, and the setting and cultural context in which it is provided. Evidence that the placebo 

effect may play a potentially significant role in some 

complementary therapies has led some researchers to 

label complementary health approaches as “placebos.” 

However, some researchers claim that the placebo 

effect is a powerful force that can be effectively harnessed through complementary health approaches to 

facilitate the body’s ability to heal itself.11

The task of helping clients make informed, evidencebased decisions about complementary health approaches 

is complicated by—as just described—the lack of 

convincing data, questions about the most appropriate 

means of evaluating these practices, and the unresolved controversy over the role of placebo in treatment.1,11,12,13 Presented below are summaries of the 

existing evidence on selected complementary health 

approaches for mental or substance use disorders, as 

provided by systematic reviews and meta-analyses.

Acupuncture

Acupuncture is a low-risk, low-cost therapy that, 

based on anecdotal evidence, can relieve physical 

withdrawal symptoms, help with relaxation, and suppress cravings for drugs and alcohol.14 A small percentage of substance abuse treatment programs—4.4 

percent—offer acupuncture as an adjunct therapy.15

Some systematic reviews have focused specifically 

on acupuncture for treatment of disorders involving 

opioids,16,17 alcohol,18 and cocaine.19,20 These reviews 

did not find evidence of efficacy, and the authors 

have concluded that more research is needed. A 2009 

review of clinical trials found some evidence for 

acupuncture’s effectiveness with opioid withdrawal 

but not for treatment of other conditions such as 

alcohol withdrawal, nicotine relapse prevention, or 

cocaine dependence.21 A 2013 review of 48 RCTs 

testing acupuncture for use with patients who had 

alcohol, cocaine, nicotine, or opioid dependence concluded that nearly half of the clinical trials reviewed 

had at least one positive result (e.g., on craving), indicating that different types of acupuncture may have 

beneficial effects at different points in the withdrawal 

and recovery process.13

A substantial number of studies have been done on 

acupuncture as a treatment for mental disorders. A 

review published by the American Psychiatric Association’s Task Force on Complementary and Alternative 

Medicine concluded that the data do not suggest that 

acupuncture is effective in treating major depressive 

disorder.12
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Mindfulness meditation

An increasing amount of research has focused on 

mindfulness meditation, with 477 articles published 

in academic journals in 2012 alone.22 In a systematic 

review of 14 randomized and 10 nonrandomized 

controlled trials, the authors found evidence that 

mindfulness-based interventions can reduce consumption of substances of abuse when compared with 

various controls, and they found preliminary evidence 

that the interventions can reduce cravings.23

Movement therapies

For the treatment of mental or substance use disorders, 

exercise is theorized to provide social and psychological benefits by increasing socialization, improving emotional regulation, decreasing sensitivity to 

anxiety, and improving stress management. It is also 

postulated that because exercise triggers neurological 

effects similar to those produced by opioid drugs, 

exercise may serve as a substitute for substance use.24

Exercise to promote physical, mental, emotional, or 

spiritual health is called movement therapy. Some 

studies have investigated movement therapies in 

relation to specific mental or substance use disorders. 

A 2013 meta-analysis of 37 RCTs found that exercise 

is moderately more effective than no therapy or 

a control intervention for reducing symptoms of 

depression.25 A 2011 meta-analysis of 10 RCTs found 

that yoga-based interventions have a statistically 

significant effect when used as an adjunct for treating severe mental illness, especially when current 

treatment modalities are inadequate or have adverse 

effects (e.g., weight gain, cardiovascular disease).26 A 

2014 review of eight studies on yoga for treatment of 

addictions reported that seven of those studies showed 

positive effects; the article authors concluded that the 

results are “encouraging but inconclusive” because of 

methodological limitations.27

Although evidence of exercise’s effect on mental and 

substance use disorders is inconclusive, the benefits of 

routine physical exercise for overall health, wellness, 

and quality of life are well documented. At the least, 

exercise can be a helpful adjunct therapy to behavioral health treatment, and clients may benefit from 

participation in a movement-based complementary 

practice such as yoga, Pilates, or tai chi. A doctor’s 

guidance on appropriate types of exercise or movement therapy is advised for clients who are pregnant, 

have a specific medical condition (e.g., multiple sclerosis, back injury, osteoporosis), or have not exercised 

in a long time.

Natural products

Of the many dietary supplements marketed to consumers as having mental health benefits, two of the 

most popular are omega-3 supplements and SAMe 

(S-adenosyl methionine). Some omega-3 fatty acids 

are essential nutrients obtained from food sources 

such as fatty fish and certain plants such as flax. 

SAMe is a chemical that is naturally found in almost 

all tissues in the body. Exhibit 4 provides evidence of 

effectiveness and cautions for both of these products.

Many herbal products are also marketed to consumers 

for treatment of mental disorders. Exhibit 4 lists two 

examples, kava and St. John’s wort. Among the many 

other botanicals marketed as treatments for mental 

health conditions are brook mint for anxiety or insomnia, chamomile for insomnia, lavender for anxiety or 

insomnia, linden for insomnia and nervous tension,28

passion flower for insomnia and anxiety,28,29 and valerian for anxiety.28,30

RCTs and systematic reviews provide little evidence 

that homeopathic medicines are effective for any specific condition.4

 The key ingredient can be extremely 

diluted, so the principle of action does not appear to 

be science-based. Even when the main ingredient is 

highly diluted, there may be other active ingredients 

in the mixture, including alcohol and metals, that can 

cause side effects and drug interactions.4
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Exhibit 4. Examples of Natural Products Marketed 

to Consumers for Treatment of Mental Disorders

Product Example 

of Use

Evidence of 

Effectiveness

Cautions

Omega-3 fatty 

acids (found in 

fatty fish, flax, 

and other dietary 

sources)

Depression May have benefit as 

an adjunct to standard 

pharmacologic therapy 

for depression.31

May interact with anticoagulants.32

SAMe (chemical 

found naturally in 

the body)

Depression May have benefit as 

an adjunct to standard 

pharmacologic therapy 

for depression.31

Close medical supervision is advised for 

patients with bipolar disorder or on tricyclic 

antidepressants.29

Kava (Piper 

methysticum,

plant)

Anxiety May have anxiolytic 

effect.31

Safety risks outweigh benefits.31

Adversely interacts with several classes of drugs, 

including some sedatives, benzodiazepines, and 

monoamine oxidase inhibitors (MAOIs).29

Has been linked to severe liver damage.33

Should not be taken with alcohol because of risk of 

excessive sedation and harm to the liver.29

St. John’s wort 

(Hypericum 

perforatum, herb) 

Depression Some evidence 

exists to support use 

for treating mild to 

moderate depression in 

adults.31

Active compounds in St. John’s wort interact with 

other medications to render them less effective 

and potentially cause serious side effects. Such 

herb–drug interactions have been documented for 

MAOIs and selective serotonin reuptake inhibitors, 

used to treat depression. Interactions have also 

been documented for medications to treat other 

conditions, including HIV/AIDS, Parkinson’s 

disease, and cancer. St. John’s wort can also 

interfere with the efficacy of oral contraceptives, 

anticonvulsants, immunosuppressants used with 

transplantation, anticoagulants, and other types of 

medications.29

Products made from St. John’s wort vary 

considerably in the quantity and quality of their 

active compounds, leading to variability in 

interactive and other side effects.34

Note: Information on the utility, efficacy, and safety of other nutritional supplements can be obtained from PDR for Nutritional Supplements 

(2008).35 This reference book provides monographs on nutritional supplements currently in use, and it indexes those monographs in multiple ways, 

including by indications, side effects, and interactions. Information on herbal products can be obtained from PDR for Herbal Medicines (2007).29

This reference book includes monographs indexed by indications, side effects, herb–drug interactions, and safety, among other categories.
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Ayurvedic medicine has not been sufficiently studied 

in RCTs to determine effectiveness.3 Ayurvedic medicines in the subset called rasa shastra have additional 

ingredients deliberately added; these additives may 

include metals, minerals, and gems. A study of 230 

such products purchased over the Internet from India 

or the United States found that nearly 21 percent 

contained detectable levels of lead, mercury, or 

arsenic.36

What Guidance Can Behavioral 

Health Service Practitioners Offer?

Practitioners can help clients understand that 

the offered treatment and support services are 

evidence-based; that is, high-quality research has 

shown the services to have positive outcomes. 

A practitioner can also help a client realize the 

importance of practitioner–client communication 

about complementary therapies, to ensure that any 

such therapies that the client tries are supported by 

evidence of effectiveness and do not present risk of 

side effects or adverse interactions. Suggestions for 

managing the practitioner–client conversation follow.

● Be prepared with language to explain to clients the 

meaning of “evidence-based” and to succinctly 

describe how any recommended treatment and 

services have been evaluated. Be ready to explain 

that if a first course of treatment is not effective in 

moving the client into sustained recovery, other 

evidence-based courses of treatment can be tried.

● Become better informed about complementary 

health approaches and the evidence base and 

cautions for these practices in behavioral health 

treatment (see Resources).

● Question clients about the use of complementary 

practices during intake and at regular intervals. 

Ask clients to report all therapies they use for 

any purpose, not just for treatment of a mental or 

substance use disorder. Convey tolerance and respect 

when discussing clients’ use of complementary 

health approaches, and support their interest in 

asserting control over their own health.

● Encourage clients who are taking or considering 

taking any natural products (including Ayurvedic, 

homeopathic, or naturopathic remedies) to confer 

with a medical care practitioner or pharmacist. 

Urge clients who are pregnant or nursing to talk 

with their prenatal care practitioner. Advise clients 

on prescription medication to confer with their 

medical care practitioners about potential herb–

drug interactions. Advise clients who will be 

undergoing surgery to confer with their medical 

care practitioners about any use of herbal medicines, 

because some can affect heart rate, blood pressure, 

or rate of bleeding and therefore should not be used 

for 2 to 3 weeks before surgery.37

● Advise clients seeking to improve their overall 

health through dietary supplements not to 

overlook the importance of a nutritious diet and 

exercise. Direct clients to nutritional counseling 

and information sources on safe and appropriate 

exercise.

● Advise clients that a great deal of misinformation 

about the safety and efficacy of complementary 

practices exists, especially on the Internet. Refer 

them to credible resources for evidence-based 

information (see Resources).

Resources

Academic Consortium for Integrative Medicine 

and Health

List of Consortium schools offering clinicallyoriented training opportunities

www.imconsortium.org/training_jobs/opportunities

-clinical.cfm

American Psychiatric Association Practice 

Guidelines

www.psychiatryonline.org/guidelines

The Cochrane Library 

Searchable database of systematic reviews of research 

on health practices, including complementary health 

approaches

http://cochrane.org
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Food and Drug Administration

Tips for Dietary Supplement Users

www.fda.gov/Food/DietarySupplements

/UsingDietarySupplements/ucm110567.htm

Integrative Medicine at Yale

List of free online educational modules

http://medicine.yale.edu/integrativemedicine

/education/resources.aspx

National Center for Complementary and 

Integrative Health

Be an Informed Consumer (factsheets and resources)

http://nccih.nih.gov/health/decisions

Health Topics A–Z

http://nccih.nih.gov/health/atoz.htm 

Online Continuing Education Series (free online 

video lectures; continuing education credits available)

http://nccih.nih.gov/training/videolectures

Office of Dietary Supplements

Information for professionals and the public 

http://ods.od.nih.gov

Notes

1 National Center for Complementary and Alternative Medicine. 

(2011). Exploring the science of complementary and 

alternative medicine: Third strategic plan, 2011–2015. NIH 

Publication No. 11-7643. Bethesda, MD: Author.

2 Barnes, P. M., Bloom, B., & Nahin, R. L. (2008). 

Complementary and alternative medicine use among adults 

and children: United States, 2007. National Health Statistics 

Reports, No. 12. Hyattsville, MD: National Center for Health 

Statistics.

3 National Center for Complementary and Alternative Medicine. 

(2013 Revision). Ayurvedic medicine: An introduction.

Retrieved August 19, 2015, from http://nccih.nih.gov/health

/ayurveda/introduction.htm

4 National Center for Complementary and Alternative Medicine. 

(2013 Revision). Homeopathy: An introduction. Retrieved 

August 19, 2015, from http://nccih.nih.gov/health/homeopathy 

5 Academic Consortium for Integrative Medicine and Health. 

(2015). About us. Retrieved August 19, 2015, from 

www.imconsortium.org/about/about-us.cfm

6 Food and Drug Administration. (2013). Questions and 

answers on dietary supplements. Retrieved August 19, 2015, 

from www.fda.gov/Food/DietarySupplements

/QADietarySupplements/default.htm

7 FDA Current Good Manufacturing Practices for Dietary 

Supplements, 21 C.F.R. Part 111 (2007). Retrieved August 19, 

2015, from www.fda.gov/OHRMS/DOCKETS/98fr/07-3039.

pdf

8 Clarke, T. C., Black, L. I., Stussman, B. J., Barnes, P. M., 

& Nahin, R. L. (2015). Trends in the use of complementary 

health approaches among adults: United States, 2002–2012. 

National Health Statistics Reports, No. 79. Hyattsville, MD: 

National Center for Health Statistics. 

9 Nahin, R. L., Barnes, P. M., Stussman, B. J., & Bloom, B. 

(2009). Costs of complementary and alternative medicine 

(CAM) and frequency of visits to CAM practitioners: United 

States, 2007. National Health Statistics Reports, No. 18. 

Hyattsville, MD: National Center for Health Statistics.

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12

ADVISORY

HHS Publication No. (SMA) 15-4921 

Printed 2015

SAMHSA Advisory

Complementary Health Approaches: Advising Clients 

About Evidence and Risks

SAMHSA Advisory

This Advisory was written and produced under contract numbers 270-09-0307 and 270-14-0445 by the Knowledge Application 

Program (KAP), a Joint Venture of JBS International, Inc., and The CDM Group, Inc., for the Substance Abuse and Mental 

Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS). Christina Currier and 

Suzanne Wise served as the Contracting Officer’s Representatives, and Candi Byrne served as KAP Project Coordinator. 

Disclaimer: The views, opinions, and content of this publication are those of the authors and do not necessarily reflect the 

views, opinions, or policies of SAMHSA or HHS.

Public Domain Notice: All materials appearing in this document except those taken from copyrighted sources are in the 

public domain and may be reproduced or copied without permission from SAMHSA or the authors. Citation of the source is 

appreciated. However, this publication may not be reproduced or distributed for a fee without the specific, written authorization 

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Electronic Access and Copies of Publication: This publication may be ordered or downloaded from SAMHSA’s Publications 

Ordering Web page at http://store.samhsa.gov. Or, please call SAMHSA at 1-877-SAMHSA-7 (1-877-726-4727) (English and 

Español).

Recommended Citation: Substance Abuse and Mental Health Services Administration. (2015). Complementary Health 

Approaches: Advising Clients About Evidence and Risks. Advisory, Volume 14, Issue 2.

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