A Possible Mechanism Underlying the Effectiveness of Acupuncture in the Treatment of Drug Addiction

Chae Ha Yang; Bong Hyo Lee; Sung Hoon Sohn

Disclosures

Evid Based Complement Alternat Med. 2008;5(3):257-266. 

In This Article

Abstract and Introduction

Abstract

Clinical trials are currently underway to determine the effectiveness of acupuncture in the treatment of drug addiction. While there are still many unanswered questions about the basic mechanisms of acupuncture, some evidence exists to suggest that acupuncture can play an important role in reducing reinforcing effects of abused drugs. The purpose of this article is to critically review these data. The neurochemical and behavioral evidence showed that acupuncture's role in suppressing the reinforcing effects of abused drugs takes place by modulating mesolimbic dopamine neurons. Also, several brain neurotransmitter systems such as serotonin, opioid and amino acids including GABA have been implicated in the modulation of dopamine release by acupuncture. These results provided clear evidence for the biological effects of acupuncture that ultimately may help us to understand how acupuncture can be used to treat abused drugs. Additional research using animal models is of primary importance to understanding the basic mechanism underlying acupuncture's effectiveness in the treatment of drug addiction.

Introduction

Acupuncture, arguably the most well-known alternative medicine treatment, has been an important therapy in Eastern countries for thousands of years. Although introduced relatively recently, acupuncture has gained popularity and greater acceptance as a treatment option in Western countries.

In oriental medicine, the human body is considered to be a complex network of intricately related processes played upon by opposing forces (Yin and Yang). Health is viewed as the maintenance of balance and harmony between Yin and Yang, while illness is an expression of unbalance and disharmony between Yin and Yang.[1] Acupuncture is an important treatment modality in manipulating and balancing Yin and Yang. Acupuncture involves the stimulation of specific points on the skin, usually by the insertion of metallic needles; however, related techniques such as manual, electrical or laser stimulation of acupuncture points are also often summarized under this term. In its original form, acupuncture was based on the principles of traditional oriental medicine. In oriental medicine, health is understood in terms of a vital force or energy called 'Qi', a metaphysical concept, which circulates between the organs along hypothesized channels called meridians. On these 'meridians', there are 365 designated acupuncture points that can be used for stimulation through needles or 'moxibustion' to balance and harmonize Yin and Yang by relieving blockages in the flow of 'Qi'. Qi energy must flow in the correct strength and quality through each of these meridians and organs for health to be maintained. The acupuncture points are located along the meridians and provide one means of altering the flow of Qi. Thus, the supposed principle of acupuncture in oriental medicine is correcting the unbalanced and disharmonized flow of Qi by stimulating the relevant points on the body surface.[2,3] Conformation of acupuncture's role for homeostasis by manipulating and balancing Yin and Yang was shown, when the body's innate homeostatic potentialities are overwhelmed by acute-or chromic-stress conditions.[4]

Complementary therapies are widely used throughout the world, but in fact their effectiveness is quite controversial.[5,6] Among them, acupuncture is one of the spotlighted treatments on the field of illness which is hard to cure in the modern western medicine. Acupuncture as a therapeutic intervention has been widely practiced for the treatment of many functional disorders including substance abuse and mental illness in Eastern countries through diverse methods such as manual acupuncture, electroacupuncture and acupoint nerve stimulation.[7] Importantly, acupuncture has become a standard procedure in many detoxification programs for drugs, worldwide.[8,9] While more scientific studies are needed to confirm the efficacy and define the physiological mechanisms of acupuncture, the National Institutes of Health Consensus Development Panel issued a report in 1977 stating 'Acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program'.[10] Also, in 1997, a consensus panel issued by the NIH cautiously concluded that acupuncture might be efficacious in the treatment of post-operative and chemotherapy nausea and vomiting, nausea of pregnancy and post-operative dental pain, including drug addiction.[11]

Addiction treatment programs increasingly use a combination of conventional and complementary/alternative medicine (CAM) method as acupuncture. Many studies in acupuncture have used auricular acupuncture for the treatment of addictions in patients, stimulating on a 3–4 point including Shenmen auricular point. However, the clinical data obtained from effects of auricular acupuncture for drug addiction have not been consistent. Several works have shown that auricular acupuncture did not provide significant contribution over, and above, that achieved by conventional treatment alone in reduction of alcohol and cocaine use[12,13] and was not more effective than needle insertion at control point in reducing cocaine use.[14] The existing data fail to document the benefit of acupuncture in treating cocaine addiction as the sole treatment at this time. However, some evidence exists to suggest that acupuncture can be beneficial in the treatment of cocaine addiction as an adjunctive therapy.[13] Importantly, there is considerable evidence to support that electroacupuncture at body points is also particularly effective in alleviating the withdrawal syndrome in heroin addicts.[15,16] These findings are intriguing in light of the fact that recent clinical studies have brought the search for the difference between body and auricular points in the efficacy of acupuncture in the treatment of drug addiction.

Only a few experiments using animal models have been performed to determine the basic mechanisms underlying acupuncture's effectiveness in the treatment of drug addiction. Unfortunately, very little is known about the effects of acupuncture in a situation where drugs of abuse are used on a chronic basis and how chronic use of drug effects both neurochemical and behavioral changes. However, it has been generally accepted that acupuncture treatment can contribute to the biochemical balance in the central nervous system and maintenance or recovery of homeostasis.[17,18] Additionally, results of some animal studies regarding drug addiction have provided evidence for the involvement of neurotransmitters in the action of acupuncture.[19] Additional research using animal models is of primary importance to understanding the basic mechanisms of acupuncture. The present article will explore studies directed at elucidating the neurobiological mechanism of acupuncture on drug addiction with focus on Yin and Yang theory.

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