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Note to the TCM Community

Chinese Medicine and Chemical Dependency: Some Pertinent Questions




"The Book" - Transformation and Recovery: A Guide to the Design and Development of Acupuncture-Based Chemical Dependency Treatment Programs

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(edited from Transformation and Recovery: A Guide for the Design and Development of Acupuncture-Based Chemical Dependency Treatment Programs)

The increased public interest in the use of acupuncture in the treatment of chemical dependency has raised some important questions for the Chinese medical community in the United States. It woud have been serendipitous, from an idealistic perspective, had the application of auricular therapy in treating addiction waited to emerge until Chinese medicine had achieved a foothold of acceptance in general health care in this culture, so that the chemical dependency treatment establishment could have found that medicine more professionally established. But the reality has been otherwise. Chinese medicine is an infant in a foreign land, lacking the sort of strong legal, political, and social foundations that would allow it to be strong, clear, deliberate, and unified in its response to this keen and growing demand for its assistance. Instead, unfortunately, the TCM community has been found somewhat divided in a degree of controversy around a number of key issues precipitated by the adaptations required of Chinese medicine in the unique setting of substance abuse treatment and recovery in Western culture.

Some of the issues that divide the community are clinical in nature. Traditional Chinese medical texts (like their Western counterparts) are silent on the subject of alcoholism and drug addiction. So we are on a clinical frontier. With the complexities of the pathologies inherent in chronic drug addiction, generally tangled up as they are with a host of attending pathologies, we must acquiesce to the fact that final resolution of the many clinical questions that arise from a continuum of substance abuse treatment will result from thoughtful debate, research, and clinical experience over a substantial period of time.

Other dividing issues are, not surprisingly, economic in nature. As the popularity of "acudetox" grows, and with mounting acceptance of the therapy on the part of the federal government, funding is generally soon to increase. Who will do the work? Who will certify that the work is done properly? And, of course, who will profit?

Five complex and related issues face the acupuncture profession in the area of educational and certification standards involving work with chemical dependency clients. These issues can be stated as follows:

  1. What general educational standards, if any, concerning alcoholism, drug addiction, and substance abuse should be developed and adopted for the certification of all individuals who practice traditional Chinese medicine or acupuncture in the United States? How should such standards be developed, and by whom? What political priority should be given to implementing these standards, especially in "new" States who will be in the process of enacting acupuncture certification laws in the next several years?
  2. In place of or addition to these standards, what level of clinical training and supervision ought to be established for individuals administering acupuncture protocols in public chemical dependency treatment settings? How should these standards be developed, and by whom? In developing these standards, should any concessions be made in regions of the country where the numbers of licensed acupuncturists is not adequate to delivering services?
  3. Are there optimum, generic acupuncture protocols that should be used in first-phase recovery in a chemical dependency setting? What sort of research has already been accomplished, and what additional research is required in order to make this determination? How and by whom should such determinations be made? If such generic protocols are found to be appropriate, what is the proper relationship of expanded traditional Chinese medical protocols in these treatment settings to the generic protocol?
  4. What process for resolution of these issues is indicated in the current political and funding environment? Might these issues be prioritized in a manner that would require that some of them are deserving of more rapid resolution than others? What is the appropriate interface of the Chinese medical community with the chemical dependency treatment community in the resolution of these issues? Is there justification for the formation of a special "Commission" representative of Oriental medical associations that is charged with resolving these issues? If so, how should such a Commission be comprised, and what existing organizations or groups ought it to represent? What sources of funding are possible to finance the work of such a Commission?
  5. What various impacts might the resolution of these issues, and the manner in which they are resolved, have upon the overall level of acceptance of Chinese medicine and acupuncture in the delivery of general health care in the United States? How might these influences be weighed?
Few would question the general need for an increased awareness of substance addiction and abuse on the part of practitioners of Chinese medicine and acupuncture in the United States. In spite of the enlightened work of many Western physicians in the field of alcoholism and substance abuse, Western medicine in general has made the error of operating in the vacuum and substantially denying the role addiction plays in other health maladies. So, too, has the Western counseling and psychotherapy community. Both of these groups, in their tendency to address the attending or underlying syndromes that frequently accompany substance issues, have often in fact served to enable alcoholics and addicts to continue chronic use, even often complicating the condition through the prescription of other psychoactive drugs.

It would be a tragic loss to those who suffer from drug addiction if Chinese medicine, with its substantial and elegant arsenal of protocols that are relevant to addiction disorders, made the same mistake that Western medicine and psychology have made - proceeding in relative ignorance of the issues that make substance abuse such an endemic malaise in Western culture.

The fact is that addiction in American culture is, in some measure, a Western malady. Since traditional Chinese texts, and the curriculum of colleges of Oriental medicine, do not address the issue of addiction, practitioners must educate themselves, or else develop meaningful networks with chemical dependency treatment and recovery resources in the communities they serve. The National Acupuncture Detoxification Association (NADA) has been providing trainings for acupuncturists in chemical dependency since 1985, but this training has been focussed on specialized acupuncture protocols in the public treatment setting, and does not emphasize the assessment, referral, or clinical skills that prepare individuals in private practice for a successful response to chemical dependency issues.

It is, of course, in large measure the result of the successful work of NADA in developing public, flourshing, acupuncture-based chemical dependency treatment programs throughout the world, and in the research that has resulted, that the concerns we have expressed above have taken on such significance. Funding of acupuncture-based chemical dependency treatment is likely to increase, perhaps dramatically, in the near future, and it behooves the Chinese medical community to address the issues listed above in anticipation of this potential integrative pathway into general health care in the United States.




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