Drink and Drugs News DDN July 2018 | Page 8

Complementary therapies


the myths ?

Arecent essay published by Drug and Alcohol Findings asked whether acupuncture can treat acute substance use problems and disorders or relieve symptoms of withdrawal , and included a healthy dose of scepticism about whether acupuncture ‘ works ’ at all . No doubt some readers thought it went too far in its criticism of acupuncture , and others that it had not gone far enough to distance the practice from accepted evidence-based treatments .

Building on that essay , I want to explore how language may be blurring the lines between alternative and conventional treatments , and why resistance to acupuncture may be more an issue of ethical resistance to placebos , making acupuncture a topical vehicle through which to debate their use .
Traditional acupuncture has been developed over 2,000 years in China , Japan , and other East Asian countries . A self-regulated profession in the UK , traditional acupuncture is delivered outside the NHS alongside other alternative and complementary therapies . Western medical acupuncture , on the other hand , is sometimes available on the NHS but most often paid for privately , and delivered by medical practitioners such as doctors , physiotherapists and nurses as an add-on to their conventional professional practice .
The NHS Choices website doesn ’ t equate acupuncture with conventional treatment , but does distinguish ‘ Western medical acupuncture ’ from ‘ non-medical acupuncture ’ or ‘ traditional Chinese medicine acupuncture ’ – the first at least sounding more like a conventional treatment . Allied with this is the medical language explaining how it works and the stipulation that Western medical acupuncture is used following a medical diagnosis .
Traditional acupuncture is based on the idea that problems with our health and wellbeing can surface when vital energy known as Qi ( pronounced ‘ chee ’) is prevented from flowing freely throughout the body , and works by restoring the flow of this so-called ‘ life force ’. In contrast , Western medical acupuncture reincarnates acupuncture as a procedure that stimulates sensory nerves ( as opposed to ‘ energy ’) under the skin and in muscles , causing the body to produce endorphins and other naturally-occurring chemicals .
Acupuncture adherents cite the benefits of treating the person not the condition , and claim in doing so that acupuncture can not only maintain good health and prevent bad health , but improve one ’ s overall sense of wellbeing . For people so inclined , the gentle insertion of hair-thin , flexible needles is reported to be relaxing , and at the site of the needles is sometimes associated with pain-free feelings of heaviness , aching , tingling and warmth .

For the NHS , acupuncture is currently only recommended for chronic tension-type headaches and migraines , but is also used to treat other types of pain . In the substance use field acupuncture has been a popular alternative treatment for people with cocaine use problems – though this may have had more to do with the lack of an accepted conventional treatment than the particular merits of acupuncture , and the need for acupuncture itself may be illusory as just about any psychosocial therapy helps some of these clients some of the time .

A 2006 assessment from the respected Cochrane collaboration of whether acupuncture at sites on the ear has helped in the treatment of cocaine dependence found definitively that , ‘ There is currently no evidence that auricular acupuncture is effective for the treatment of cocaine dependence ’. As evidence was limited and from methodologically poor studies , the assessment stopped short of saying that acupuncture was ineffective 1 . Across the spectrum and range of substance use issues , the same or similar conclusions apply .
It could be argued that offering something concrete like acupuncture which both clients and staff believe to be worthwhile might aid a person ’ s recovery by attracting them to services , and – as some studies have suggested – helping to retain them in treatment . However , the defence of acupuncture in the absence of evidence of effectiveness would then almost certainly take us into the territory of ‘ placebos ’ – inert procedures wrapped up as medical treatments that may exert an effect , but only to the extent that patients expect or believe they will have an effect .
Any of the perceived ethical ambiguity of placebos was stripped out by a commentary published in the American Journal of Bioethics by Dr Alain Braillon , an alcohol treatment specialist in France 2 . Disputing their ‘ benign ’ connotations , Braillon argued that placebos fundamentally compromise the precious relationship between doctor and patient , ‘ strengthen medical arrogance ’, ‘ infantilise people ’, and ‘ can delay the proper diagnosis of a serious medical condition ’. As he saw it ,
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