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Ear Acupuncture according to the NADA (National Acupuncture Detoxification Association)

  • March 2019
DOI: 10.3390/medicines6020044
Authors:
Gerhard Litscher at Medical University of Graz
Gerhard Litscher
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Abstract

This editorial is a brief report on the National Acupuncture Detoxification Association (NADA) ear acupuncture and is intended to briefly summarize the main scientific work. The complementary addiction-detoxification auricular acupuncture method has not been sufficiently experimentally explored in many areas. There have been clinical studies, some of which contradict the success. A total of 27 referenced publications were found that refer to the method that has existed for many decades and should be briefly listed here.
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medicines
Editorial
Ear Acupuncture according to the NADA (National
Acupuncture Detoxification Association)
Gerhard Litscher
Research Unit for Complementary and Integrative Laser Medicine, Research Unit of Biomedical Engineering in
Anesthesia and Intensive Care Medicine, and TCM Research Center Graz, Medical University of Graz,
Auenbruggerplatz 39, EG19, 8036 Graz, Austria; gerhard.litscher@medunigraz.at; Tel.: +43-316-385-83907;
Fax: +43-316-385-595-83907
Received: 26 March 2019; Accepted: 28 March 2019; Published: 31 March 2019


Abstract:
This editorial is a brief report on the National Acupuncture Detoxification Association
(NADA) ear acupuncture and is intended to briefly summarize the main scientific work. The
complementary addiction-detoxification auricular acupuncture method has not been sufficiently
experimentally explored in many areas. There have been clinical studies, some of which contradict
the success. A total of 27 referenced publications were found that refer to the method that has existed
for many decades and should be briefly listed here.
Keywords: ear acupuncture; National Acupuncture Detoxification Association (NADA)
According to the literature, the special ear acupuncture according to the National Acupuncture
Detoxification Association (NADA) protocol is an addiction-detoxification method, but in the scientific
literature, as in many areas of ear acupuncture, it has not yet been adequately researched in
experimental and clinical studies from the point of view of numerous scientific experts. In the
scientific database PubMed, as of 21 March 2019, there were a total of 27 referenced publications that
refer to the method that has existed for more than 30 years.
Hong Kong’s Dr. H. L. Weng was one of the earliest researchers to report in 1972 and 1973 that
acupuncture on four body points and two points on the ear using electrical stimulation was able to
support opiate withdrawal in addicts. Cui and coworkers from the Neuroscience Institute of Peking
University in China reported on this in both Chinese and English [
1
,
2
]. The second step was taken
by Dr. Michael Smith of New York, head of NADA/USA in 1985, using only ear points to treat drug
abuse. The 1988 publication by Smith and Khan [
3
] includes reports of 200 patients at the Lincoln
Hospital in New York over a period of 13 years, starting in 1975. There have been reports of subjective
successes, which, however, were not objectively scientifically proven at that time.
Sixteen years later, ‘NADA acupuncture’ reappears in referenced scientific papers. In Europe,
more specifically in Stockholm, the research group around Berman et al. published an article in 2004 [
4
]
using NADA ear acupuncture among prison inmates to alleviate mental and physical complaints and
reduce their drug use. Over a period of 18 months, 163 men and women were examined; however, no
significant differences to other methods were found, although there were no negative side effects.
The next study also dates back to 2004 and was based on a significant increase in England
depending on the use of cocaine among 16- to 29-year-olds. In 2000, England had the highest
consumption of cocaine in Europe, affecting 3.3% of all young adults [
5
]. In a review article, the
following question was asked: “Is acupuncture effective in the treatment of cocaine addiction?” Six
randomized controlled trials met the inclusion criteria and were considered. The author could not
confirm that acupuncture was an effective treatment for cocaine abuse.
Medicines 2019,6, 44; doi:10.3390/medicines6020044 www.mdpi.com/journal/medicines
Medicines 2019,6, 44 2 of 5
Another study on the potential effectiveness of NADA acupuncture in the treatment of cocaine
addiction was provided by Kim et al. from Tucson, USA [
6
]. Again, a positive effect of NADA
acupuncture could not be clearly demonstrated. The lack of clinical trials is explicitly stated, and the
authors state that further efforts should be made in this area [6].
The next international study in a peer-reviewed journal of NADA acupuncture was from Margolin
et al. from the Yale University School of Medicine, New Haven, USA [
7
]. In this 2005 study,
40 HIV-positive cocaine users received acupuncture according to the NADA protocol (Figure 1).
In addition to the acupuncture treatment, patients also received group therapy. Depression and anxiety
were examined. The results showed no measurable success of acupuncture. However, patients who
received group therapy in addition to acupuncture treatment were formerly abstinent and showed a
greater reduction in depression and anxiety than those who did not receive group therapy.
Medicines 2019, 2 of 5
Another study on the potential effectiveness of NADA acupuncture in the treatment of cocaine
addiction was provided by Kim et al. from Tucson, USA [6]. Again, a positive effect of NADA
acupuncture could not be clearly demonstrated. The lack of clinical trials is explicitly stated, and the
authors state that further efforts should be made in this area [6].
The next international study in a peer-reviewed journal of NADA acupuncture was from
Margolin et al. from the Yale University School of Medicine, New Haven, USA [7]. In this 2005 study,
40 HIV-positive cocaine users received acupuncture according to the NADA protocol (Figure 1). In
addition to the acupuncture treatment, patients also received group therapy. Depression and anxiety
were examined. The results showed no measurable success of acupuncture. However, patients who
received group therapy in addition to acupuncture treatment were formerly abstinent and showed a
greater reduction in depression and anxiety than those who did not receive group therapy.
Figure 1. NADA auricular points (schematically): (1) Sympathetic, (2) Shen Men, (3) Kidney, (4) Liver,
(5) Lung.
In another study performed in 2011 in Canada, subjects were assigned to one of three treatment
groups (NADA auricular acupuncture, auricular acupuncture at sham points, or treatment setting
control). Anxiety was assessed using a pretest–posttest treatment design. In this study, the NADA
protocol was not more effective than the sham or treatment setting control in reducing anxiety [8].
NADA was also used at Danish rehabilitation institutions and drug centers [9]. Motives for offering
NADA acupuncture were most often some positive experienced effects. A randomized controlled
trial design with the objectives to evaluate the feasibility and possible benefits of self-administered
auricular acupressure (NADA) as a non-invasive alternative to pharmacotherapy has also been
suggested for smoking cessation [10]. Interviews in Sweden were conducted with 15 patients treated
at an outpatient clinic for substance dependence [11]. All participants appreciated NADA treatment.
“Auricular acupuncture for chemically dependent pregnant women: a randomized controlled trial of
the NADA protocol” is the title of an interesting study, again from Canada [12]. The authors observed
that among the newborns of women who were compliant with the acupuncture regime, there was a
reduction of 2.1 and 1.5 days in the length of treatment for neonatal abstinence syndrome when
compared to the non-compliant and control groups, respectively. However, the differences were not
statistically significant. Another article from New York describes the auricular acupuncture and
acupressure program developed for a university setting and its use as a tool to enhance harm
reduction and mental health services [13]. In a publication from Beijing, the efficacy of acupuncture
and related techniques for the treatment of drug dependence was reviewed. Possible mechanisms
underlying these effects were also discussed [14]. At the University of Colorado in Denver, 185
Figure 1.
NADA auricular points (schematically): (1) Sympathetic, (2) Shen Men, (3) Kidney, (4) Liver,
(5) Lung.
In another study performed in 2011 in Canada, subjects were assigned to one of three treatment
groups (NADA auricular acupuncture, auricular acupuncture at sham points, or treatment setting
control). Anxiety was assessed using a pretest–posttest treatment design. In this study, the NADA
protocol was not more effective than the sham or treatment setting control in reducing anxiety [
8
].
NADA was also used at Danish rehabilitation institutions and drug centers [
9
]. Motives for offering
NADA acupuncture were most often some positive experienced effects. A randomized controlled trial
design with the objectives to evaluate the feasibility and possible benefits of self-administered auricular
acupressure (NADA) as a non-invasive alternative to pharmacotherapy has also been suggested for
smoking cessation [
10
]. Interviews in Sweden were conducted with 15 patients treated at an outpatient
clinic for substance dependence [
11
]. All participants appreciated NADA treatment. “Auricular
acupuncture for chemically dependent pregnant women: a randomized controlled trial of the NADA
protocol” is the title of an interesting study, again from Canada [
12
]. The authors observed that among
the newborns of women who were compliant with the acupuncture regime, there was a reduction
of 2.1 and 1.5 days in the length of treatment for neonatal abstinence syndrome when compared to
the non-compliant and control groups, respectively. However, the differences were not statistically
significant. Another article from New York describes the auricular acupuncture and acupressure
program developed for a university setting and its use as a tool to enhance harm reduction and mental
health services [
13
]. In a publication from Beijing, the efficacy of acupuncture and related techniques
Medicines 2019,6, 44 3 of 5
for the treatment of drug dependence was reviewed. Possible mechanisms underlying these effects
were also discussed [
14
]. At the University of Colorado in Denver, 185 patients completed a study.
The use of NADA acupuncture was positively correlated with both the successful completion of the
study as well as successful tobacco cessation [
15
]. Other authors from the USA reported that NADA
acupuncture is a simple, standardized, 1–5 point auricular needling protocol that is increasingly
recognized as a universally useful intervention in the treatment of addictions [
16
]. Researchers from
the Medical University of Graz in Austria (TCM Research Center Graz) used NADA ear acupuncture
in an adolescent patient with phantom limb pain after surgery for osteosarcoma [
17
] and authors
from Germany implemented the method in geriatric patients suffering from major depression [
18
,
19
].
Significant pre–post improvements indicated a potential benefit [
18
]. Impulsivity has characteristics
that are manifested clinically in behaviors such as disinhibition, poor self-control, lack of deliberation,
thrill seeking, and risk-taking. NADA acupuncture also holds promise as a useful treatment adjunct
in the management of disorders for which impulsivity is a prominent component [
20
]. On the one
hand, the results from a publication in Neuroscience Letters from 2016 provides some support for
the evidence-based use of NADA acupuncture as a new adjunctive approach that can improve the
side-effects of morphine and other opioids [
21
]. On the other hand, no evidence was found that
NADA acupuncture was more effective than relaxation for problems with anxiety, sleep or substance
use, or in reducing the need for further addiction treatment in patients with substance use problems
and comorbid psychiatric disorders [
22
]. Results from Germany showed that treatment with NADA
acupuncture in patients with anxiety disorders or major depressive disorders significantly decreased
tension, anxiety, and anger/aggression, but did not elevate mood. Between NADA acupuncture and
progressive muscle relaxation, no statistically significant differences were found. Thus, the authors
suggest that both methods may be useful as equally-effective additional interventions in the treatment
of the above mentioned disorders [23].
Stuyt and Voyles stated that NADA acupuncture has evolved into the most widely implemented
acupuncture-assisted protocol, not only for substance abuse, but also for broad behavioral health
applications [
24
]. Promising, early randomized-controlled trials were followed by a mixed field of
positive and negative studies. The authors recommended that, going forward, research continues
to explore the comparison of the NADA protocol added to accepted treatments to those treatments
alone, recognizing that it is not a stand-alone procedure, but a psychosocial intervention that affects
the whole person and can augment outcomes from other treatment modalities [24].
“NADA Protocol for Behavioral Health. Putting Tools in the Hands of Behavioral Health
Providers: The Case for Auricular Detoxification Specialists” is the title of an article published in
Medicines recently in 2018 [
25
]. Data presented there support the idea that conditions conducive to
auricular detoxification specialist practice led to greater implementation [25].
Baker and Chang [
26
] from the USA performed a systematic review at the end of 2016, which
was the first to focus explicitly on randomized trials utilizing the NADA protocol as a complementary
intervention to address opioid use disorder. Only four trials met the inclusion criteria. The results
indicated that while the NADA protocol may not be effective in reducing acute opiate craving or
withdrawal, it may be effectively utilized as an adjunctive treatment to increase treatment retention
and decrease methadone detoxification and maintenance dosages in opioid use disorder [
26
]. In a
randomized prospective study performed in 2017 to determine if NADA plus traditional treatment
enhanced outcomes, participation in NADA showed better positive results [27].
Funding:
The scientific work on ear acupuncture at the TCM Research Center Graz is partly supported by the
German Academy of Acupuncture (Pres. Dr. Bernd Ramme).
Conflicts of Interest: The author declares no conflict of interest.
Medicines 2019,6, 44 4 of 5
References
1.
Cui, C.L.; Wu, L.Z.; Luo, F.; Han, J.S. Acupuncture for the treatment of drug addiction. Sheng Li Ke Xue Jin
Zhan 2008,39, 325–330. (In Chinese) [CrossRef]
2.
Cui, C.L.; Wu, L.Z.; Luo, F. Acupuncture for the treatment of drug addiction. Neurochem. Res.
2008
,33,
2013–2022. [CrossRef] [PubMed]
3.
Smith, M.O.; Khan, I. An acupuncture program for the treatment of drug-addicted persons. Bull. Narc.
1988
,
40, 35–41. [PubMed]
4.
Berman, A.H.; Lundberg, U.; Krook, A.L.; Gyllenhammar, C. Treating drug using prison inmates with
auricular acupuncture: A randomized controlled trial. J. Subst. Abuse Treat. 2004,26, 95–102. [CrossRef]
5.
D’Alberto, A. Auricular acupuncture in the treatment of cocaine/crack abuse: A review of the efficacy,
the use of the National Acupuncture Detoxification Association protocol, and the selection of sham points.
J. Altern. Complement. Med. 2004,10, 985–1000. [CrossRef]
6.
Kim, Y.H.; Schiff, E.; Waalen, J.; Hovell, M. Efficacy of acupuncture for treating cocaine addiction: A review
paper. J. Addict. Dis. 2005,24, 115–132. [CrossRef]
7.
Margolin, A.; Avants, S.K.; Arnold, R. Acupuncture and spirituality-focused group therapy for the treatment
of HIV-positive drug users: A preliminary study. J. Psychoact. Drugs 2005,37, 385–390. [CrossRef]
8. Black, S.; Carey, E.; Webber, A.; Neish, N.; Gilbert, R. Determining the efficacy of auricular acupuncture for
reducing anxiety in patients withdrawing from psychoactive drugs. J. Subst. Abuse Treat.
2011
,41, 279–287.
[CrossRef]
9.
Skovgaard, L.; la Cour, S.; Kristensen, M. Use of complementary and alternative medicine at Danish
rehabilitation institutions and drug centres. Ugeskr. Laeger. 2012,174, 39–41. (In Danish)
10.
Leung, L.; Neufeld, T.; Marin, S. Effect of self-administered auricular acupressure on smoking cessation—A
pilot study. BMC Complement. Altern. Med. 2012,12, 11. [CrossRef] [PubMed]
11.
Bergdahl, L.; Berman, A.H.; Haglund, K. Patients’ experience of auricular acupuncture during protracted
withdrawal. J. Psychiatr. Ment. Health Nurs. 2014,21, 163–169. [CrossRef]
12.
Janssen, P.A.; Demorest, L.C.; Kelly, A.; Thiessen, P.; Abrahams, R. Auricular acupuncture for chemically
dependent pregnant women: A randomized controlled trial of the NADA protocol. Subst. Abuse Treat. Prev.
Policy 2012,7, 48. [CrossRef]
13.
Oyola-Santiago, T.; Knopf, R.; Robin, T.; Harvey, K. Provision of auricular acupuncture and acupressure in a
university setting. J. Am. Coll. Health 2013,61, 432–434. [CrossRef]
14.
Cui, C.L.; Wu, L.Z.; Li, Y.J. Acupuncture for the treatment of drug addiction. Int. Rev. Neurobiol.
2013
,111,
235–256. [CrossRef]
15.
Stuyt, E.B. Ear acupuncture for co-occurring substance abuse and borderline personality disorder: An aid
to encourage treatment retention and tobacco cessation. Acupunct. Med.
2014
,32, 318–324. [CrossRef]
[PubMed]
16.
Carter, K.; Olshan-Perlmutter, M. NADA protocol: Integrative acupuncture in addictions. J. Addict. Nurs.
2014,25, 182–187. [CrossRef] [PubMed]
17.
Kurath-Koller, S.; Bauchinger, S.; Sperl, D.; Leithner, A.; Urlesberger, B.; Raith, W. Use of NADA ear
acupuncture in an adolescent patient with phantom limb pain after surgery for osteosarcoma. Acupunct.
Med. 2015,33, 82–84. [CrossRef] [PubMed]
18.
Geib, J.; Rieger, M.A.; Joos, S.; Eschweiler, G.W.; Metzger, F.G. Implementation of auricular acupuncture by
the NADA protocol in geriatric patients suffering from major depression: A mixed methods feasibility study.
Z. Gerontol. Geriatr. 2017,50, 316–324. [CrossRef] [PubMed]
19.
Geib, J.; Rieger, M.A.; Joos, S.; Eschweiler, G.W.; Dresler, T.; Metzger, F.G. Introduction of auricular
acupuncture in elderly patients suffering from major depression: Protocol of a mixed methods feasibility
study. BioMed Res. Int. 2015,2015, 678410. [CrossRef]
20.
Carter, K.; Olshan-Perlmutter, M. Impulsivity and stillness: NADA, pharmaceuticals, and psychotherapy in
substance use and other DSM 5 disorders. Behav. Sci. 2015,5, 537–546. [CrossRef]
21.
Kattalai Kailasam, V.; Anand, P.; Melyan, Z. Establishing an animal model for National Acupuncture
Detoxification Association (NADA) auricular acupuncture protocol. Neurosci. Lett.
2016
,624, 29–33.
[CrossRef]
Medicines 2019,6, 44 5 of 5
22.
Ahlberg, R.; Skårberg, K.; Brus, O.; Kjellin, L. Auricular acupuncture for substance use: A randomized
controlled trial of effects on anxiety, sleep, drug use and use of addiction treatment services. Subst. Abuse
Treat. Prev. Policy 2016,11, 24. [CrossRef] [PubMed]
23.
De Lorent, L.; Agorastos, A.; Yassouridis, A.; Kellner, M.; Muhtz, C. Auricular acupuncture versus progressive
muscle relaxation in patients with anxiety disorders or major depressive disorder: A prospective parallel
group clinical trial. J. Acupunct. Meridian Stud. 2016,9, 191–199. [CrossRef] [PubMed]
24.
Stuyt, E.B.; Voyles, C.A. The National Acupuncture Detoxification Association protocol, auricular
acupuncture to support patients with substance abuse and behavioral health disorders: Current perspectives.
Subst. Abuse Rehabil. 2016,7, 169–180. [CrossRef] [PubMed]
25.
Stuyt, E.B.; Voyles, C.A.; Bursac, S. NADA protocol for behavioral health. Putting tools in the hands of
behavioral health providers: The case for auricular detoxification specialists. Medicines
2018
,5, 20. [CrossRef]
26.
Baker, T.E.; Chang, G. The use of auricular acupuncture in opioid use disorder: A systematic literature
review. Am. J. Addict. 2016,25, 592–602. [CrossRef] [PubMed]
27.
Carter, K.; Olshan-Perlmutter, M.; Marx, J.; Martini, J.F.; Cairns, S.B. NADA ear acupuncture: An adjunctive
therapy to improve and maintain positive outcomes in substance abuse treatment. Behav. Sci.
2017
,7, 37.
[CrossRef] [PubMed]
©
2019 by the author. Licensee MDPI, Basel, Switzerland. This article is an open access
article distributed under the terms and conditions of the Creative Commons Attribution
(CC BY) license (http://creativecommons.org/licenses/by/4.0/).
... In 1972 and 1973, Weng HL from Hong Kong and Cui from the Neuroscience Institute of Beijing described the first study of acupuncture's effects on opiate withdrawal in addiction (14). In 1985, Smith (15), head of the National Acupuncture Detoxification Association (NADA) in New York, United States, used only five points on the ear to treat drug abuse. In Germany, Raben (16,17) described acupuncture using the NADA points to treat both non-pregnant and pregnant drug-dependent women. ...
... Manifestations of NAS were observed at a median of 1st day after delivery (range 1-4 days). The median Finnegan score was 12 points (range [6][7][8][9][10][11][12][13][14][15][16][17][18]. The length of hospital stay in the neonatal intensive care unit had a median of 46.5 days (range . ...
... NADA is an American association that supports use of acupuncture for drug withdrawal in adults. Under the NADA concept, drug addicts are treated "vegetativum, shen men, kidney, liver, and lung" EAP, thus resulting in positive effects (15). ...
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... Modern studies show that ear acupuncture was performed to characterize the levels of pro-inflammatory and anti-inflammatory cytokines. [21][22][23] To the extent of our knowledge, such a rigorously designed systematic review and meta-analysis on ear acupuncture in the treatment of AS has not yet been presented in the related literature. This review aims to assess the efficacy and safety of ear acupuncture in AS treatment at home and abroad to provide evidence-based medicine for clinical practice. ...
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... The effects of neural stimulation for the treatment of neuropsychiatric diseases, using taVNS or percutaneous auricular stimulation as used in the recently FDA approved devices, appear to be very similar to auricular acupuncture which has been widely used for substance use disorders Baker and Chang 2016;Litscher 2019). Acupuncture has been shown to be effective for treating opioid withdrawal (Kaniusas et al. 2019;Mercante et al. 2018a;Mercante et al. 2018b;Chen et al. 2018). ...
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Full-text available
  • Feb 2018
Background: The National Acupuncture Detoxification Association (NADA) protocol, a simple standardized auricular treatment has the potential to provide vast public health relief on issues currently challenging our world. This includes but is not limited to addiction, such as the opioid epidemic, but also encompasses mental health, trauma, PTSD, chronic stress, and the symptoms associated with these conditions. Simple accessible tools that improve outcomes can make profound differences. We assert that the NADA protocol can have greatest impact when broadly applied by behavioral health professionals, Auricular Detoxification Specialists (ADSes).Methods:The concept of ADS is described and how current laws vary from state to state. Using available national data, a survey of practitioners in three selected states with vastly different laws regarding ADSes, and interviews of publicly funded programs which are successfully incorporating the NADA protocol, we consider possible effects of ADS-friendly conditions.Results:Data presented supports the idea that conditions conducive to ADS practice lead to greater implementation. Program interviews reflect settings in which adding ADSes can in turn lead to improved outcomes.Discussion:The primary purpose of non-acupuncturist ADSes is to expand the access of this simple but effective treatment to all who are suffering from addictions, stress, or trauma and to allow programs to incorporate acupuncture in the form of the NADA protocol at minimal cost, when and where it is needed. States that have changed laws to allow ADS practice for this standardized ear acupuncture protocol have seen increased access to this treatment, benefiting both patients and the programs.
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NADA Ear Acupuncture: An Adjunctive Therapy to Improve and Maintain Positive Outcomes in Substance Abuse Treatment
Article
Full-text available
  • Jun 2017
The National Acupuncture Detoxification Association protocol (NADA) is an adjunctive therapy using 1 to 5 invariant ear acupuncture/acupressure points. This is a randomized prospective study to determine if NADA plus traditional treatment enhance outcomes: quality of life, depression, anxiety and abstinence from substance abuse. There were 100 patients enrolled in the Keystone Substance Abuse Services-Winthrop University Department of Sociology and Anthropology NADA study. All patients completed Generalized Anxiety Disorder scale (GAD-7), Patient Health Questionnaire (PHQ-9), Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES) prior to starting the program and at program completion. Patients self-reported alcohol, tobacco, and drug use prior to starting the program at program completion and at 3 and 6 month follow- up. Patient characteristics are predictive of completion versus non-completion when race, criminal history and initial drug test is considered. Those identified as nonwhite, (p < 0.05) and patients with positive initial drug test, (p < 0.01) were more likely to complete treatment in the NADA group. Also, among patients with criminal history a higher percentage failed to complete the program in the control group (p < 0.05). Participation in NADA positively associated with Q-LES score (p < 0.05), feeling better about oneself and improved energy (p < 0.05), likelihood of employment upon discharge (p < 0.05), and decreased alcohol use at 3 month follow up (p < 0.05) and 6-month follow-up (p < 0.01). NADA group reported less tobacco use at 6 months (p < 0.05).
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The National Acupuncture Detoxification Association protocol, auricular acupuncture to support patients with substance abuse and behavioral health disorders: current perspectives
Article
Full-text available
  • Dec 2016
Elizabeth B Stuyt,1 Claudia A Voyles2 1Department of Psychiatry, University of Colorado Health Sciences Center, Pueblo, CO, 2Department of Clinical Studies, AOMA Graduate School of Integrative Medicine, Austin, TX, USA Abstract: The National Acupuncture Detoxification Association (NADA)-standardized 3- to 5-point ear acupuncture protocol, born of a community-minded response to turbulent times not unlike today, has evolved into the most widely implemented acupuncture-assisted protocol, not only for substance abuse, but also for broad behavioral health applications. This evolution happened despite inconsistent research support. This review highlights the history of the protocol and the research that followed its development. Promising, early randomized-controlled trials were followed by a mixed field of positive and negative studies that may serve as a whole to prove that NADA, despite its apparent simplicity, is neither a reductive nor an independent treatment, and the need to refine the research approaches. Particularly focusing on the last decade and its array of trials that elucidate aspects of NADA application and effects, the authors recommend that, going forward, research continues to explore the comparison of the NADA protocol added to accepted treatments to those treatments alone, recognizing that it is not a stand-alone procedure but a psychosocial intervention that affects the whole person and can augment outcomes from other treatment modalities. Keywords: National Acupuncture Detoxification Association (NADA), ear acupuncture, acudetox, addiction, mental health, trauma
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Auricular acupuncture for substance use: A randomized controlled trial of effects on anxiety, sleep, drug use and use of addiction treatment services
Article
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Background A common alternative treatment for substance abuse is auricular acupuncture. The aim of the study was to evaluate the short and long-term effect of auricular acupuncture on anxiety, sleep, drug use and addiction treatment utilization in adults with substance abuse. Method Of the patients included, 280 adults with substance abuse and psychiatric comorbidity, 80 were randomly assigned to auricular acupuncture according to the NADA protocol, 80 to auricular acupuncture according to a local protocol (LP), and 120 to relaxation (controls). The primary outcomes anxiety (Beck Anxiety Inventory; BAI) and insomnia (Insomnia Severity Index; ISI) were measured at baseline and at follow-ups 5 weeks and 3 months after the baseline assessment. Secondary outcomes were drug use and addiction service utilization. Complete datasets regarding BAI/ISI were obtained from 37/34 subjects in the NADA group, 28/28 in the LP group and 36/35 controls. Data were analyzed using Chi-square, Analysis of Variance, Kruskal Wallis, Repeated Measures Analysis of Variance, Eta square (η2), and Wilcoxon Signed Ranks tests. Results Participants in NADA, LP and control group improved significantly on the ISI and BAI. There was no significant difference in change over time between the three groups in any of the primary (effect size: BAI, η2 = 0.03, ISI, η2 = 0.05) or secondary outcomes. Neither of the two acupuncture treatments resulted in differences in sleep, anxiety or drug use from the control group at 5 weeks or 3 months. Conclusion No evidence was found that acupuncture as delivered in this study is more effective than relaxation for problems with anxiety, sleep or substance use or in reducing the need for further addiction treatment in patients with substance use problems and comorbid psychiatric disorders. The substantial attrition at follow-up is a main limitation of the study. Trial registration Clinical Trials NCT02604706 (retrospectively registered).
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Impulsivity and Stillness: NADA, Pharmaceuticals, and Psychotherapy in Substance Use and Other DSM 5 Disorders
Article
Full-text available
  • Nov 2015
Pharmaceuticals and psychotherapy are commonly used in the management of impulsivity. The National Acupuncture Detoxification Association (NADA) protocol is an adjunctive therapy that involves the bilateral insertion of 1 to 5 predetermined ear needle points. One of the main benefits reported by patients, providers, and programs utilizing NADA is the sense of stillness, centering, and well-being. The induction of this attitude is seen as contributing to improved clinical outcomes including engagement and retention. The attitude of stillness is also suggestive of a pathway to mitigating impulsivity. Impulsivity is associated with substance use disorders and other DSM 5 diagnoses. Impulsivity has characteristics that are manifested clinically in behaviors such as disinhibition, poor self-control, lack of deliberation, thrill seeking, risk-taking. NADA holds promise as a useful treatment adjunct in the comprehensive management of disorders for which impulsivity is a prominent component.
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Introduction of Auricular Acupuncture in Elderly Patients Suffering from Major Depression: Protocol of a Mixed Methods Feasibility Study
Article
Full-text available
Background: Due to an increasing number of elderly people suffering from major depression and potential side effects of the prescribed drugs, the introduction of new therapeutic approaches is needed. Currently, in Germany, auricular acupuncture is no part of clinical care for gerontopsychiatric patients. Based on promising clinical experiences and existing evidence for treating addiction and trauma, a benefit of auricular acupuncture integrated in existing treatment programs in elderly patients may be hypothesized. Within this project auricular acupuncture according to the National Acupuncture Detoxification Association (NADA) will be integrated in the multimodal treatment regime for elderly patients with major depression in a daytime ward setting. Methods/design: To evaluate the feasibility and acceptance a mixed method approach is used. In a day clinic, a sample of 20 psychogeriatric patients with the diagnosis of major depression will be enrolled. The patients will receive a total of nine auricular acupuncture treatments according to the standardized NADA protocol in a group setting. The therapeutic process, its organization, the experience, and the willingness of patients to participate will be evaluated by interviews with patients and the therapeutic team. Data will be analyzed qualitatively using content analysis. Additionally, quantitative outcome parameters will be measured by standardized questionnaires.
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The use of auricular acupuncture in opioid use disorder: A systematic literature review: The Use of Auricular Acupuncture in Opioid Use Disorder
Article
  • Oct 2016
Background and objectives: Opioid use disorder (OUD) is a chronic disease with significant personal, societal, and public health consequences. Even for the minority who receive the most effective evidence-based treatments, morbidity, and mortality remain significant. These facts, along with the recovery movement calling for individualized, holistic, culturally sensitive care, have led to the exploration of adjunctive interventions including acupuncture. Despite hundreds of international trials, however, there is a lack of consensus regarding its efficacy in OUD due in large part to methodological issues of trials to date. In response to these issues, the National Acupuncture Detoxification Association (NADA) developed an operationalized manual auricular acupuncture protocol that has since become the most widely used in the US. This systematic review is the first to focus explicitly on randomized trials utilizing the NADA protocol as a complementary intervention to address OUD. Methods: The methods utilized to identify studies for inclusion are based on a 2009 protocol developed by the Cochrane Collaboration. Results: Four trials met inclusion criteria. Despite methodological issues, results indicate that while the NADA protocol may not be effective in reducing acute opiate craving or withdrawal, it may be effectively utilized as an adjunctive treatment to increase treatment retention and decrease methadone detoxification and maintenance dosages in OUD. Conclusion and scientific significance: Incorporation of the NADA protocol into existing evidence-based treatment approaches may facilitate recovery and, through its impact on treatment retention and completion, indirectly impact morbidity, and mortality in individuals with OUD. Given the limitations of the current review, conclusions are tentative and directions for future research are discussed. (Am J Addict 2016;25:592-602).
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Establishing an animal model for National Acupuncture Detoxification Association (NADA) auricular acupuncture protocol
Article
  • May 2016
The use of opioids in the treatment of chronic pain has increased dramatically in the past few decades making them one of the most commonly prescribed medications in the US. However, long-term use of opioids is limited by development of tolerance (decreased antinociceptive efficacy) and opioid-induced hyperalgesia − paradoxical sensitization to noxious (hyperalgesia) and non-noxious (allodynia) stimuli. Novel adjunctive therapies are needed to increase the efficacy and prolong the duration of action of opioids in chronic pain treatment.
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Implementierung von Ohrakupunktur nach dem NADA-Protokoll bei geriatrischen Patienten mit einer depressiven Episode: Eine Machbarkeitsstudie mit gemischten Methoden
Article
  • May 2016
Background The number of elderly patients with depression has steadily increased in recent years; therefore, new treatment options and therapy approaches are urgently needed to improve treatment in this patient group. The aim of this project was to evaluate the additional application of auricular acupuncture according to the NADA protocol in patients treated in a daytime ward in terms of acceptability and feasibility. Methods A total of 20 psychogeriatric patients from a daytime clinic suffering from major depression (ICD-10: F32–F33) received auricular acupuncture in addition to the standard treatment three times per week over a treatment course of 3 weeks. Semi-structured interviews were conducted with the participants and the therapeutic team and qualitative content analyses were carried out. Depression, cognition, quality of sleep and quality of life were assessed using validated quantitative instruments. Results There was a 95 % utilization of the therapy. The qualitative analysis showed a high acceptance by all participants. The dominant perception by the patients was a positive expectation and conviction that acupuncture was an effective form of therapy without side effects, which could contribute to recovery. The majority of patients also felt that there was an improvement in the symptoms. The quantitative analysis revealed significant improvements in the target parameters. Conclusion The acceptance of the intervention by the patients and the willingness of the interdisciplinary team underlines the feasibility of this implementation within a fixed therapeutic concept. The significant pre-post improvements indicated a potential benefit and should be verified in further efficacy studies.
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Auricular Acupuncture Versus Progressive Muscle Relaxation in Patients with Anxiety Disorders or Major Depressive Disorder: A Prospective Parallel Group Clinical Trial
Article
  • Apr 2016
Although acupuncture treatment is increasingly in demand among psychiatric patients, to date no studies have investigated the effectiveness of auricular acupuncture (AA) in treating anxiety disorders (AD) or major depressive disorder (MDD). Thus, this study aimed to compare the effectiveness of AA versus progressive muscle relaxation (PMR), a standardized and accepted relaxation method. We examined 162 patients with a primary diagnosis of AD or MDD, and each patient chose between treatment with AA, executed according to the National Acupuncture Detoxification Association (NADA) protocol, and treatment with PMR. Each group had treatments twice a week for four weeks. Before and after treatment, each participant rated four items on a visual analog scale (VAS): anxiety, tension, anger/aggression, and mood. Statistical analyses were performed with the original VAS scores and the Change-Intensity (CI) Index, an appropriate indicator of the difference between two values of a variable. Our results show that treatment with AA significantly decreased tension, anxiety, and anger/aggression throughout the four weeks, but did not elevate mood. Between AA and PMR, no statistically significant differences were found at any time. Thus, we suggest that both AA and PMR may be useful, equally-effective additional interventions in the treatment of the above-mentioned disorders.
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