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Feature Articles - Alternative
Sunday, 30 September 2001
In the treatment of addictive disorders, there is no magic bullet. No known intervention can cure every person, or even the majority of people, suffering from addictive disorders. As a result, patients, clinicians, and researchers alike are still searching for better, stronger, widely effective therapies to use in the treatment of addictions. Complementary and Alternative Medicine (CAM) has entered the addiction medicine field through this doorway and has become more than an obscure curiosity. However, high-quality data regarding efficacy is still limited for the majority of CAM therapies.

Preliminary data suggest that some of these modalities may have efficacy and, even if not a cure, they may provide patients with symptomatic relief. This article will provide a basic overview of CAM and addiction research for clinicians so that they: a) can begin to answer patients' questions about CAM therapies, and b) may better evaluate CAM therapies as potential treatment alternatives for patients for whom traditional therapies have been ineffective or unacceptable.

The label "CAM" represents a wide range of interventions, too numerous to name, which are not currently considered an integral part of the conventional medical system. To simplify discussion, the National Center for Complementary and Alternative Medicine (NCCAM), part of the National Institutes of Health, classifies CAM therapies into five domains: 1) mind-body interventions; 2) biologically based treatments; 3) manipulative and body-based methods; 4) energy therapies; and 5) alternative medical systems (http://nccam.nih.gov/fcp/classify).

These categories are not necessarily mutually exclusive. For example, botanical remedies are typically considered a biologically based treatment. Yet they also comprise the standard of care in several alternative systems of medicine, including Traditional Chinese Medicine (TMC) and Ayurvedic medicine. Instead of cross-listing modalities in several categories, each has been placed in the category that best represents its use in the treatment of substance abuse.

A number of methodological challenges face researchers conducting both substance abuse and CAM studies (Culliton et al., 1996). One of the hallmarks of CAM therapies is the holistic approach to patients, i.e., therapists focus on treating the person rather than attacking a disease. However, critics suggest that much of CAM research lacks this clinical relevance, tending to focus on the disease rather than the individual. Standardized protocols, such as those commonly used in acupuncture and botanical research, eliminate the person-centered nature of each therapy. Thus we are left to wonder whether these trials accurately test the efficacy of the modality.

Concerns about the validity of CAM and substance abuse studies go beyond the selection of an appropriate therapeutic model. Researchers often fail to control for the extent of substance use in terms of frequency, quantity, and number of substances, and often use inadequate comparison or control groups. In addition, researchers rely on a wide variety of criteria to assess treatment success, including abstinence, decreased use, decreased cravings, diminished withdrawal symptoms, treatment retention, and improved outlook. While one study may evaluate decreased substance use as success, another group may focus strictly on abstinence rates, thus making the evaluation and comparison of studies difficult. All of these factors should remind us to be cautious in the interpretation of data, both positive and negative.

How it breaks down

1. Mind-Body Interventions: The NCCAM describes mind-body interventions as those techniques which stimulate the mind's potential to influence bodily function and symptoms. This section will discuss the following:
  • Hypnosis
  • Biofeedback
  • Meditation
  • Restricted Environmental
Stimulation Therapy (REST)
  • Eye Movement Desensitization and Reprocessing (EMDR)
  • Prayer
  • Relaxation
Hypnosis: Hypnosis is the most frequently researched CAM modality for smoking cessation. One difficulty in assessing the research findings is that hypnotic procedures have not been standardized for the treatment of addictions, and more than 20 different strategies may be used (Katz, 1980). Results from controlled clinical trials for smoking cessation vary widely, with abstinence (success) rates ranging from 4 to 88 percent (Culliton et al., 1999). A randomized controlled trial (N=180) published in 1986 demonstrated significant short-term efficacy in the treatment of nicotine addiction compared to controls (Lambe et al., 1986). However, these findings are questionable, as 50 percent of the hypnosis group dropped out of the study after being randomized; they were excluded from analysis rather than counted as treatment failures. In addition to the work on smoking cessation, several studies of hypnosis have focused on alcoholism, the majority of which have generated negative or inconclusive findings.

Biofeedback: Many forms of biofeedback have been used in the treatment of addictive disorders. Although in the early 1970s, Alpha EEG biofeedback was said to be ineffective for treating substance abuse, the recent addition of theta brainwave training to the protocol has launched a new wave of interest (Fahrion, 1995; Peniston et al., 1990). EMG biofeedback techniques, which require subjects to reduce muscle tension rather than alter brain waves, have also been used (Denney et al., 1991; Taub et al., 1994). The majority of clinical and research findings have been positive for the treatment of alcoholism, and the few reports available on the treatment of opiate and nicotine addictions also have been positive. However, as with hypnosis, methodological problems reduce our confidence in these findings. In addition, there is evidence to suggest that consumption of alcohol or nicotine can significantly impair performance during EMG biofeedback sessions, which could have a negative impact on its clinical usefulness (Boucher et al., 1998).

Meditation: Despite the variety of meditation styles available, the only one that has received formal attention in the substance abuse literature is Transcen-dental Meditation (TM). Since its introduction to the United States in the 1960s, controversy has surrounded TM. Pro-ponents claim that TM is a cure for conditions such as high blood pressure, chronic pain, and addictions, and that regular practice can lower crime rates. Critics accuse the Maharishi Mahesh Yogi (who introduced TM to the U.S.) and his followers of deceptive practices and fraud, and some even cite evidence of harm resulting from the practice of TM (Singer, 1992; Skolnick, 1992).

More than 30 studies have been conducted on the treatment of substance abuse using TM (O'Connell et al., 1995). Rates of success have ranged from 65 percent in a controlled trial of alcohol dependence in a recidivist population, to 98 percent in a retrospective analysis of drug use among TM program participants. However, all of the studies conducted to date have been performed by researchers directly affiliated with the Maharishi and TM. In addition, research generally fails to control for drug of abuse or history of use, lacks appropriate randomization and controls, and tends to measure success by a reduction in use rather than abstinence. Thus, while TM shows some promise for the treatment of substance abuse, well-designed, independent studies still need to be conducted.

Restricted Environmental Stimula-tion (REST): Academic interest in the field of restricted environmental stimulation therapy (REST) and sensory deprivation began in the 1950s and 1960s. By the 1970s, research had expanded to include the treatment of smoking and drinking behaviors (Suedfeld et al., 1972; Rank et al., 1978). Chamber REST takes place in a light- and sound-proof room for 12 to 24 hours with only a bed, toilet and access to food. Flotation REST is also conducted in an enclosed room where the individual lies in a pool of heated water supersaturated with Epsom salts (Borrie, 1990-1991). Both flotation and chamber REST have shown positive results in preliminary studies for the treatment of alcohol dependence, although only chamber REST has shown positive results in the treatment of nicotine addiction (Boucher et al., 1998). Once again, however, the quality of these studies can be criticized, and larger, well-designed studies must be conducted before proper conclusions may be drawn.

EMDR, Prayer, Relaxation: EMDR, a relatively new psychological method, is being recommended by proponents for the treatment of drug dependence, particularly when patients have a history of mental trauma (Shapiro et al., 1994). The belief is that eye movement can stimulate the brain's self-healing capacities. No published research has yet verified the efficacy of this method in substance abuse treatment. Although spirituality/prayer is heavily incorporated into substance abuse treatment protocols and could perhaps be considered conventional, there still has been no direct research into prayer alone outside of the 12-step programs. Whether prayer, either by or for a patient, is a nonspecific (placebo) treatment or whether it is effective in the treatment of drug dependence has yet to be determined. Relaxation therapies have long been thought useful in the treatment of substance abuse; however, the modality has not fared well in evaluations of past research. One study (Ormrod et al., 1991) did demonstrate a reduction of anxiety in subjects, but this did not translate to a reduction in consumption.

2. Biologically Based Treatments: The products, practices, and interventions classified as biologically based include botanicals, vitamins, and other dietary supplements. Special dietary therapies designed to prevent or control disease are also included in this category. Many of the products overlap conventional medicinal uses of dietary supplements, such as the use of prenatal vitamins during pregnancy to prevent illness in both mother and child. The following two groups fall under this heading:
  • Botanical Medicines
  • Special Dietary Therapies
Botanical Medicines: Botanical medicines have been used throughout the world for the treatment and prevention of disease and are incorporated into many systems of medicine, such as traditional Chinese medicine (TCM). A number of botanicals serve as the foundation for today's modern-day pharmaceuticals, white willow bark (aspirin), foxglove (digitalis) and, more recently, yew (taxol). Botanicals are touted as natural alternatives to conventional, often synthetic, drugs. But while many have an impressive safety profile, others can cause serious problems if used improperly. The majority of research on botanical medicines for the treatment of substance abuse has been conducted on the green menace of the South, kudzu (Pueraria lobata). Animal studies using kudzu and kudzu-containing compounds have shown significantly reduced freechoice ethanol intake (Xie et al., 1994; Lee, 1996). However, the first preliminary clinical trial found that kudzu did not significantly reduce alcohol consumption in treated subjects compared to controls. While a handful of botanical trials have been conducted using botanicals for the treatment of opiate dependence, much work still remains to be done before any specific products can be recommended.

Special Dietary Therapies: Western science recognizes the link between basic vitamin-mineral deficiencies and some severe, chronic, and even terminal diseases. However, to date a link between nutritional deficiencies and substance abuse has not been solidly established (although excessive use of drugs may cause nutritional deficiencies). Prelimin-ary clinical trials looking at nutritional programs (diet changes), supplements (amino acids, vitamins), and nutritional education for the treatment of alcohol dependence have shown promise (Biery et al., 1991; Mathews-Larson et al., 1987; Brown et al., 1990; Blum et al., 1988). One trial also showed promising results in patients dependent on cocaine (Horne, 1988), and several studies have reported that withdrawal symptoms and freechoice ethanol consumption were reduced in animals treated with various nutrients (Boucher et al., 1998). Once again, further research is required before preliminary results can be confirmed.

3. Manipulative and Body-Based Methods: Interventions which involve the manipulation and/or movement of the body, such as chiropractice and massage, are included under this heading. Which therapies should be classified as movement-based is debatable; for example, NCCAM lists dance therapy as a mind-body intervention and Qigong as an energy therapy, although both involve movement of the body. For the purposes of this article, I have classified yoga and tai chi as movement-based because of the wide range of theories about their mechanism of action and the philosophies surrounding their practice. This category includes:
  • Massage
  • Yoga
  • Tai Chi
Massage: Massage is always contraindicated for people who are under the influence of alcohol or other drugs. It may be useful for individuals in recovery, although no research is available on this population. One small study was done looking at reduction in smoking (Hernandez-Reif et al., 1999). Subjects (N=20) conducted regular self massages of the hand, and compared to controls they reported fewer withdrawal symptoms and smoked fewer cigarettes. Although this preliminary study is of interest, we still know very little about the efficacy of massage in the treatment of nicotine addiction.

Yoga and Tai Chi: It has been suggested that the postures, breathing, and meditation that comprise the practice of yoga may be useful for the treatment of substance abuse. Preliminary studies have not shown promise for the treatment of opiate dependence (Shaffer et al., 1997), but little research has been conducted. Tai chi, one of the martial arts typically practiced in the U.S. as a series of slow-moving postures, has been suggested as a possible treatment for substance abuse. At this time no anecdotal evidence or clinical studies have been published.

4. Energy Therapies: Energy therapies are those which seek to manipulate energy fields both internal (biofields) and external (electromagnetic fields) to the body. Although the existence of these fields has not been proven to the satisfaction of the entire scientific community, therapies such as acupuncture, magnetic fields, and therapeutic touch have gained considerable popularity. These therapies may include:
  • Acupuncture/Electro-acupuncture
  • Neuroelectric Therapy (NET)
  • Therapeutic Touch
  • Light Therapy
Acupuncture: There have been more than 60 English-language research publications focusing on acupuncture and electro-acupuncture for the treatment of substance abuse. In addition, several review articles have been published assessing the quality and outcomes of these studies (Culliton et al., 1999). Still, despite the quantity of research, there is still no consensus as to the efficacy of this treatment for the majority of substance abuse disorders. The National Institutes of Health (NIH) released a consensus statement on acupuncture in November 1997 (volume 15, number 5), in which they concluded that acupuncture may be a useful adjunct or acceptable alternative treatment for addictive disorders, with one exception. The final report clearly stated, "There is evidence that acupuncture does not demonstrate efficacy for cessation of smoking." Based on existing evidence, this was the only disorder for which acupuncture was deemed not useful. Since the NIH report was issued, the first large-scale randomized clinical placebo controlled trial was completed, using acupuncture for the treatment of cocaine dependence (Bullock et al., 1999). Researchers concluded that there was no evidence to suggest that acupuncture combined with conventional substance abuse treatment for cocaine abuse was more effective than conventional substance abuse treatment alone.

Neuroelectric Therapy (NET): Also known as transcranial or cranial neuroelectric stimulation, NET was originally used in the 1950s for the treatment of insomnia (Brewington et al., 1994). In a typical treatment session, low amperage and frequency alternating current is used to stimulate surface electrodes placed in the mastoid region (behind the ear). The majority of research has focused on opiate addiction (approximately nine out of 15 studies); the others focus on alcohol and cocaine addictions (Boucher et al., 1998). Generally speaking, support for the use of NET in the treatment of addictive disorders is weak. While some preliminary trials have had promising outcomes, our confidence in these findings is minimized by their methodological flaws and by the negative findings of better controlled trials (Gariti et al., 1992; Taub et al., 1994).

Light Therapy and Therapeutic Touch: Proponents have advocated the use of light therapy as an adjunct to conventional treatment in patients with seasonal patterns of alcohol dependence. However, the prevalence, and even the existence, of seasonal patterns of alcoholism have not been conclusively demonstrated (Eastwood et al., 1978; Poikolainen, 1982). Clinical and controlled research data on the efficacy of light therapy is lacking. The same is true for Therapeutic Touch, which is reportedly used in the treatment of some addictive disorders but on which no research has been published.

5. Alternative Medical Systems: Conventional (biomedical) medicine is not the only systematic approach to the prevention and treatment of disease. Other systems of medicine, many of which predate the conventional approach, have evolved and been used by cultures throughout the world. These alternative medical systems consist of developed methods for treating patients and often complex theories about maintaining health and preventing disease:
  • Homeopathy
  • Traditional Chinese Medicine (TCM)
  • Ayurvedic Medicine
Homeopathy: Homeopathy, the use of highly diluted substances, including minerals and plants, in a water-alcohol solution, is being used to treat substance abuse in parts of Europe and to a lesser extent the U.S. Once an established alternative to biomedicine in the United States, homeopathy is based on the principle that certain active substances, when diluted, are able to cure symptoms similar to those which they cause (Mirman, 1994). In part because the final solution may be diluted to a concentration far beyond the point at which any molecules of the medicine can be detected, homeopathy faces heavy criticism (NIH, 1994). To date, no one has been able to provide an adequate scientific explanation for its possible mechanism. Homeopathy has traditionally been practiced by providing individualized remedies for patients. However, standardized formulas for various ailments and illnesses are now available for purchase. No research on the efficacy of this practice in treating addictions has been published in the United States.

Traditional Chinese Medicine and Ayurvedic Medicine: There have been no studies on the treatment of substance abuse using systems of Traditional Chinese Medicine (TCM) or Ayurvedic medicine. While components of each of these systems have been used and researched, such as acupuncture, yoga, TM, and botanicals, it is unlikely that these systems as a whole will be evaluated any time soon due to the significant clinical and methodological problems researchers would face.

Over the millennia, the Chinese have tested plants for their properties of inducing cold, heat, warmth, and coolness. They classified the medicinal effects of the plants on the various parts of the body, then tested their toxicity and what doses would be lethal. In addition, the client's living environment is assessed, along with his life rhythms and the foods he prefers or avoids, in order to better understand the illness.

Once the excesses or imbalances are pinpointed, they can be adjusted, and the Chinese believe physical and mental health and balance restored (see "Traditional Chinese Medicine" by John Scott and Claudia Voyles on page 27 of this issue).

Ayurveda, however, is a holistic system of healing which evolved among the Brahmin sages of ancient India approximately 3,000-5,000 years ago (http://niam.com). It focuses on establishing and maintaining balance of the life energies within us, rather than focusing on individual symptoms.

It also recognizes the unique constitutional differences of all individuals and therefore recommends different regimens for different types of people. Although two people may appear to have the same outward symptoms, their energetic constitutions may be very different and therefore call for different remedies. Ayurveda seeks to heal the fragmentation and disorder of the mind-body complex and restore wholeness and harmony.

Scientific studies need to be conducted to evaluate the effectiveness of both Traditional Chinese Medicine and Ayurvedic medicine on people with addiction problems. Until conclusive research is in, however, you may want to suggest these alternative addiction treatments to your clients on an individual-by-individual basis.

Tacey Ann Boucher holds the position of Senior Research Assistant at the Center for Addiction and Alternative Medicine Research (CAAMR), housed at the Minneapolis Medical Research Foundation. In addition, she is currently finishing her PhD in sociology at the University of Minnesota.

References

Alternative Medicine: Expanding Medical Horizons: A Report to the National Insitutes of Health on Alternative Medical Systems and Practices in the United States (NIH Publication Number 94-066), 1994, Chantilly, Virginia: Prepared under the auspices of the Workshop on Alternative Medicine, Sept.14-16, 1992.
Biery, J. R., Williford, J. H., McMullen, E. A. (1991). Alcohol Craving in Rehabilitation: Assessment of Nutrition Therapy. Journal of the American Dietetic Association 91:463-466.
Blum, K., Trachtenberg, M. C., Elliott, C. E., Dingler, M. L., Sexton, R. L., Samuels, A., Cataldie, L. (1988). Enkephalinase inhibition and precursor amino acid loading improves inpatient treatment of alcohol and polydrug abusers: double-blind placebo-controlled study of the nutritional adjunct SAAVE. Alcohol 5:481-93.
Borrie, R. A. (1990-1991). The use of restricted environmental stimulation therapy in treating addictive behaviors. [Review]. International Journal of the Addictions 25:995-1015.
Boucher, T. A., Kiresuk, T. J., Trachtenberg, A. (1998). Alternative Therapies. In Graham, A.W., Schultz, T.K. (eds) Principles of Addiction Medicine, Second Edition. American Society of Addiction Medicine, Inc.
Brewington, V., Smith, M., Lipton, D. (1994). Acupuncture as a Detoxification Treatment: An Analysis of Controlled Research. Journal of Substance Abuse Treatment 11:289-307.
Brown, R. J., Blum, K., Trachtenberg, M. C. (1990). Neurodynamics of relapse prevention: a neuronutrient approach to outpatient DUI offenders. Journal of Psychoactive Drugs 22:173-87.
Bullock, M. L., Kiresuk, T. J., Pheley, A. M., Culliton, P. D., Lenz, S. K. (1999). Auricular acupuncture in the treatment of cocaine abuse: A study of efficacy and dosing. Journal of Substance Abuse Treatment 16:31-8.
Culliton, P. D., Kiresuk, T. (1996). Overview of Substance Abuse Acupuncture Treatment Research. Journal of Alternative and Complementary Medicine 2:149-159.
Culliton, P. D., Boucher, T. A., Bullock, M. L. (1999). Complementary/Alternative Therapies in the Treatment of Alcohol and Other Addictions. In Spencer, J., Jacobs, J. (eds) Complementary Medicine: An Integrated Approach. Mosby Yearbook, Inc.
Denney, M. R., Baugh, J. L., Hardt, H. D. (1991). Sobriety outcome after alcoholism treatment with biofeedback participation: A pilot inpatient study. International Journal of the Addictions 26:335-341.
Eastwood, M. R., Stiasny, L. S. (1978). Psychiatric Disorder, Hospital Admission, and Season. Archives of General Pscyhiatry 35:769-771.
Fahrion, S. L. (1995). Human Potential and Personal Transformation. Subtle Energies 6:55-88.
Gariti, P., Auriacombe, M., Incmikoski, R., McLellan, A. T., Patterson, L., Dhopesh, V., Mezochow, J., Patterson, M., O'Brien, C. (1992). A randomized double-blind study of neuroelectric therapy in opiate and cocaine detoxification. Journal of Substance Abuse 4:299-308.
Hernandez-Reif, M., Field, T., Hart, S. (1999). Smoking cravings are reduced by self-massage. Preventive Medicine 28:28-32.
Horne, D. E. (1988). Clinical Impressions of SAAVE and Tropamine. Journal of Psychoactive Drugs 20:333-336.
Katz, N. (1980). Hypnosis and the Addictions: A Critical Review. Addictive Behaviors 5:41-47.
Lambe, R., Osier, C., Franks, P. (1986). A Randomized Controlled Trial of HypnoTherapy for Smoking Cessation. Journal of Family Practice 22:61-5.
Lee, D. Y. (1996). [Animal Studies of NPI-028 for Addiction (herbal compound)]. Unpublished Data.
Mathews-Larson, J., Parker, R.A. (1987). Alcoholism treatment with biochemical restoration as a major component. International Journal of Biosocial Research 9:92-104.
Mirman, J. (1994). What the Hell Is Homeopathy? New Hope, MN: New Hope Publishers.
O'Connell, D. F., Alexander, C. N. (eds.) (1995). Self Recovery: Treating Addictions Using Transcendental Meditation and Maharishi Ayur-Veda. New York: Harrington Park Press.
Ormrod, J., Budd, R. (1991). A comparison of two treatment interventions aimed at lowering anxiety levels and alcohol consumption amongst alcohol abusers. Drug and Alcohol Dependence 27:233-43.
Peniston, E. G., Kulkosky, P. J. (1990). Alcoholic Personality and Alpha-Theta Brainwave Training. Medical Psychotherapy 3:37-55.
Poikolainen, K. (1982). Seasonality of Alcohol-Related Hospital Admissions Has Implications for Prevention. Drug Alcohol Dependence 10:65-69.
Rank, D., Suedfeld, P. (1978). Positive Reactions of Alcoholic Men to Sensory Deprivation. International Journal of the Addictions 13:807-815.
Shaffer, H. J., LaSalvia, T. A. (1997). Comparing Hatha Yoga with Dynamic Group Psychotherapy for Enhancing Methadone Maintenance Treatment: A Randomized Clinical Trial. Alternative Therapies in Health and Medicine 3:57-66.
Shapiro, F., Vogelmann-Sine, S., Sine, L. F. (1994). Eye movement desensitization and reprocessing: treating trauma and substance abuse. Journal of Psychoactive Drugs 26:379-91.
Shebek, J., Rindone, J. P. (2000). A pilot study exploring the effect of kudzu root on the drinking habits of patients with chronic alcoholism. Journal of Complementary and Alternative Medicine 6:45-8.
Singer, M. T. (1992). Closing the Chapter on Maharishi Ayur-Veda [Letter to the Editor]. JAMA 267:1337.
Skolnick, A. A. (1992). Closing the Chapter on Maharishi Ayur-Veda [Letter to the Editor]. JAMA 267:1339-1340.
Suedfeld, P., Landon, P. B., Pargament, R., Epstein, Y. M. (1972). An experimental attack on smoking: Attitude manipulation in restricted environments, III. International Journal of the Addictions 7:721-733.
Taub, E., Steiner, S. S., Weingarten, E., Walton, K. G. (1994). Effectiveness of broad spectrum approaches to relapse prevention in severe alcoholism: A long-term, randomized, controlled trial of transcendental meditation, EMG biofeedback and electronic neurotherapy. Alcoholism Treatment Quarterly 11:187-220.
Xie, C., Lin, R. C., Antony, V., Lumeng, L., Li, T. K., Mai, K., Liu, C., Wang, Q. D., Zhao, Z. H., Wang, G. F. (1994). Daidzin, an antioxidant isoflavonoid, decreases blood alcohol levels and shortens sleep time induced by ethanol intoxication. Alcoholism, Clinical Experimental Research 18:1443-7.
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