Massage is often labeled an alternative therapy in addiction treatment. Yet today’s evolving integrative health paradigm acknowledges massage, along with other body therapies, as a natural and logical instrument of human healing. The scientific study of massage is in its infancy, but recent research documents the effectiveness of massage and bears implications for the treatment of and recovery from addiction.

Even before human bodies become full bodies, touch is the first of the five senses to develop in the embryo and the most vital for survival (Dossey, B., Keegan, L. & Guzzetta, C., 2000). The skin is the largest sense organ of the body; a piece of skin the size of a quarter contains more than 3 million cells, 12 feet of nerves and approximately 900,000 sensory receptors (Dossey et al., 2000; Montagu & Matson, 1979). From this perspective, the skin is a giant communication system that, through touch, brings messages from a person’s external environment to his or her internal attention.

Given the potential powerful effects of touch, massage can play an important role in all aspects of recovery from addictions — from detoxification, when it is a valuable healing tool, through primary inpatient or outpatient treatment, when it increases awareness and promotes relaxation, to post-treatment, when it contributes to relapse prevention strategies, stress management, and the body’s innate healing power that leads to optimal health in recovery.

The history of massage
Massage has played into healing since early on in human history — some sort of healing through touch, or laying on of hands, has been part of all ancient cultures and continues into modern times. The ancient Greek and Roman physicians used massage as a principle means of removing pain. In the fifth century BC, Hippocrates, the ancient Greek physician and Father of Modern Medicine, wrote: “The physician must be experienced in many things, but assuredly in rubbing” (Lidell, Thomas, & Beresford Cooke, 2001, p.10). Most modern cultures include massage within their health care delivery system, most notably in China, where separate massage wards are found in the hospital setting. Many countries, including Germany, allow massage or other forms of touch therapy to be covered by medical insurance (Collinge & Duhl, 1997). In the immediate post-WWII era in the United States, as the practice of modern medicine became more focused on technologic and pharmaceutical interventions, massage as a medical modality was passed on from physicians’ hands to those of others — most notably physical therapists. Massage gradually lost its place as a primary medical intervention, with a few exceptions, such as in the osteopathic and chiropractic medical community. The 60s and 70s inspired a new paradigm of health and healing: revived interest in holistic measures, increased self-awareness and self-improvement, as well as optimal health, wellness, and prevention practices. As a result, massage and other forms of bodywork have received renewed attention.

Types and effects of massage
With so many different types of massage therapy and bodywork from which to choose, practitioners often blend several styles to fit their own individual philosophy, training, and intent (for an excellent, thorough review of massage therapy, see the massage chapter in Collinge & Duhl, 1997). Some massage techniques focus less on the manipulation of musculature and soft tissue and more on the integration and structure of all body parts. Oriental styles incorporate the principles of Chinese medicine and serve to maintain the flow of energy, or chi, through meridians, the energy circuits of the body. In addition, there are other energy-based modalities, such as therapeutic touch, where it is not always necessary to touch the body for positive responses, following the principle that the human energy field extends 2 to 4 inches beyond the skin and can be balanced by the actions and the intent of the practitioner.
Complementary medicine of all varieties is becoming increasingly more mainstream, a trend that will most likely continue. Unfortunately, limited research has been done in this area. This fact is changing, due in part to the National Center for Complementary and Alternative Medicine (NCCAM). Founded in 1992 by the National Institutes of Health in response to public interest, NCCAM (formerly the Office of Alternative Medicine) is now scientifically researching and evaluating alternative health modalities and funding independent research grants. Currently, many studies are also being conducted at the Miami, Florida-based Touch Research Institute (TRI), the only center in the world today devoted solely to the scientific exploration of touch and its application in healing disease.

Since TRI was established in 1991 by the University of Miami School of Medicine, the Institute has been responsible for research that has yielded significant scientific findings regarding massage and its effects on the body, among them: decreased pain, diminished autoimmune responses, enhanced immune response, increased alertness and performance, and enhanced growth in premature infants. Many of the effects appear to be related to the reduction in stress hormones, most notably cortisol, which occurs as the result of massage therapy (Field, 2002; TRI 2003). Several TRI studies completed in the past five years involve massage and addictions — specifically nicotine, bulimia, and cocaine-exposed newborns. These studies positively document the ability of massage to decrease anxiety, agitation, and cravings as well as improve sleep and lessen feelings of depression (TRI, 2003).

Massage in addiction treatment
In order to more fully understand the place that massage therapy holds in the treatment of addictions during the detoxification phase, it is important to look at the biochemistry of addiction in the brain. Much attention has been directed to the mesolimbic reward system, the so-called “pleasure pathway” of the brain. The area is activated in part by the release of the neurotransmitter dopamine, the chemical messenger responsible for making us feel good when we engage in any pleasurable activity. It is well known that dopamine is significantly involved in addiction and that dopamine levels are lower than average during the withdrawal process and into early recovery until brain chemistry normalizes. Therefore, any measure, such as massage, that can naturally increase the level of dopamine is a welcome addition to the standard pharmacological interventions most commonly used during the detoxification process. In addition, massage promotes the circulation of both blood and lymphatic fluid so that more nutrients are brought to the tissues and organ systems and toxins and other waste products are more rapidly eliminated.

All systems of the body function more efficiently with improved circulation and a reduction in tension of the soft tissues and musculature; this improvement has a positive effect on the mind and emotions as well. Psychologically, the withdrawal process can be a frightening, overwhelming experience. Massage can provide a sense of comfort, safety, and connection, and can begin to build trust in order to establish the therapeutic alliance so crucial in addiction treatment. Through massage, it seems possible to decrease the number of people who fail to complete treatment. Of course, massage therapy sessions must be individualized, taking into account each person’s prior history of touch and past touch therapy experience. The practitioner must always be highly sensitive to the particular needs of each person and their cultural perspectives.

As treatment progresses and the individual completes his or her detoxification period, massage can then be an excellent tool for increasing the client’s self awareness on all levels and continuing enhanced production of dopamine and other crucial neurotransmitters. It takes time for the body’s neurochemistry to normalize. People in early stages of recovery are generally lacking in self-esteem, self-discipline, and self-care and impatiently want to “be well, right NOW!” They are woefully separated from their body and mind, and often troubled with anxiety, depression, and insomnia. Incorporating massage into their treatment schedules — and allowing them to experience regularly what the relaxation response feels like — is time well spent. Massage offers clients awareness of how the body naturally provides pleasurable feelings and responses without the use of chemicals or addictive behaviors. This knowledge can be enlightening and positively influence their outlook toward a sober future.

Massage for clients’ body, mind, and spirit
Becoming aware of where one unconsciously holds the tension in the body turns into a wonderful advantage for clients working to identify and manage triggers, and learning how to deal with cravings and stress in general. Often, a part of the body or some sort of physical sensation can be the first notice one will receive as stress levels increase. Having a heightened kinesthetic sense and an improved awareness of habitual areas of tension in the body can provide the client with additional cues that not only may help prevent relapse, but also bring a growing respect and awe for the gift of our physical body, which for some exemplifies a Higher Power.

Mentally and emotionally, attitudes and feelings can be difficult to change or even access for the newly sober individual. Being in denial, intellectualizing, and avoiding emotions frequently hinder a full surrender to the recovery process. Referring clients to massage and bodywork can help therapists gain access to the most mentally defended individual, as massage directs attention away from the familiar region of the mind to physical realms with which they are less familiar and therefore less able to defend. Emotional release can commonly occur with massage, which provides a safe, non-threatening opportunity to begin the process of recovering long-buried emotions and memories. In this way, psychotherapeutic interventions can be greatly enhanced within the treatment setting.

Spiritually, the deep relaxation and gentle touch provided by massage can be the beginning of reconnecting with the self and ending the painful isolation every addicted person experiences. The touch of the massage therapist can powerfully, yet subtly allow a person both the opportunity to feel grounded or centered for the first time and the ability to truly be in the present moment. It also presents the opportunity to gain new insights and a deeper understanding of psychological issues and can be a valuable component of anyone’s self-care regimen. To allow oneself to surrender to the practitioner’s hands — to breathe fully and easily, to acknowledge and receive the gifts of nurturing, surrender, and relaxation — is a precious part of living the human experience and an invaluable addition to the newly recovering person’s repertoire of relapse-prevention skills.

Finishing touch
When we understand the power that touch brings, as the ancient physicians did, massage becomes a natural adjunct to treatment. The staff at the Crossroads Centre in Antigua, West Indies, recognizes this. In turn, some of the highest-rated activities clients discuss during exit interviews are the massage sessions and other holistic components of the program.
Addiction is a powerful, multifaceted disease, but as we know, it can be arrested. Clients in treatment deserve the best of all dimensions in care, so that they are optimally prepared to succeed in recovery. Massage therapy plays a role and is earning its place at the table of addiction treatment.

Joni Kosakoski, BSN, RN, CARN ( This e-mail address is being protected from spam bots, you need JavaScript enabled to view it ) has practiced nursing for more than 25 years, the last 10 specializing in addictions. She is a member of the American Holistic Nurses Association and The International Nurses Society on Addictions.

References
Collinge,W. and Duhl, L.(1997). American Holistic Health Association Complete Guide to Alternative Medicine. New York: Warner Books.
Dossey, B., Keegan, L. & Guzzetta, C. (2000) Holistic Nursing: A handbook for practice, Third edition. New York: Aspen Publishers, Inc., p.618.
Field, T. (2002). Massage therapy. Medical Clinics of North America, 86, 163-171.
Lidell, L., Thomas, S., & Beresford-Cooke, C. (2001). The Book of Massage: The Complete Step-by-Step Guide to Eastern and Western Techniques. New York: Fireside.
Montagu, A. & Matson, F. (1979). The Human Connection. New York: McGraw-Hill Book Co., pp. 89-90.
Touch Research Institute. (2003). Massage therapy database. Available: www.miami.edu/touch-research/Massage
1.html
Various authors. (December/January 2003). Massage and Bodywork, 17, 6. Selected articles on addiction and reprints available: www.massageandbodywork.com

This article is published in Counselor,The Magazine for Addiction Professionals, October 2003, v.4, n.5, pp. 36-38.

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