Engendering Change with Integrative Practices. Course Goals

Transcription

1 The Foundations of Evidence-Based Care 2015 Engendering Change with Integrative Practices Jody James Licensed Acupuncturist Dipl. O.M. (NCCAOM) Course Goals Identify (3) complementary medical modalities shown to improve treatment outcomes Identify (2) Eastern medical theories which apply to diagnosis and treatment in addiction recovery List (3+) benefits observed with the use of acupuncture in addiction recovery Understand the goals of nutritional, supplement and herbal therapies and their safety with concurrent pharmaceutical treatment 1

2 Qualifications California Licensed Acupuncturist Primary care provider Scope of practice: diagnostic, prescriptive and treatment oriented California Acupuncture Board Acupuncture Detoxification Specialist Specialized training in the physiology, psychology, pharmacology and treatment principles specific to chemical dependency and substance abuse (NADA) Synopsis of Drugs of Addiction and Symptoms of CHI s Patient Base DOA: Most Prevalent/Combos Alcohol Methamphetamine (crank, crystal, meth, speed, ice) Opiates: Heroin (horse, smack, speedballs) Opiates: Oxycodone (perks, oxy); Hydrocodone (Vicodin, Norco) Cocaine (crack, candy, coke, blow, rock, flake, C) Cannabinoids (THC, pot, weed, ganja, Mary Jane) MDMA (Ecstasy, Adam, Molly) Tobacco Caffeine States of Health Acute or post-acute withdrawal Chronic or lifelong use Recreational use addiction Symptoms Malnourishment, anorexia, unhealthy weight Insomnia, fatigue, lethargy Anxiety, anger, fear, depression, grief, numbness, hyperactivity Pain and multiple health issues Unclear thinking; erratic, risky and self harming behaviors (dual dx) Sweats, shakes, cramps, n/v, cravings, diarrhea or constipation 2

3 CHI s Integrative Practices Standard National Protocol Medical oversight (MD) includes diagnosis, health check, pharmaceutical management Psychological therapies (MFT) include individual, relational, group Psychiatry, as needed, for further evaluation (dual dx) and pharmaceuticals Non-traditional Protocols Acupuncture Nutritional therapy Herbal prescriptions Gym membership Far infrared sauna for detox Meditation, yoga, movement, body awareness Health education Optional Modalities Lymphatic drainage massage Somatic release therapy Biofeedback Pain-reduction acupuncture Program Core Activities Concurrent job, family or school responsibilities or Community involvement and volunteerism 12 Step program Case management (mentoring, problem solving) 3

4 Benefits of Holistic Treatment Published Results CASA Columbia recommendations Evidence-based studies Dismal record of failure (60-80% recidivism) with conventional treatments Alternative to drug-based protocols Experiential Access multiple pathways to healing (mind-body-spirit) True shift, not just removing a DOA from the body Team approach Lifestyle counseling and role modeling healthier choices Moving through trauma toward fulfilment 4

5 Integral Therapies Nutritional Therapy Neutriceuticals: exceed RDA for most nutrients with herbal components that support detoxification Amino acid therapy: to support neurotransmitter and healthy brain function (The Diet Cure, J. Ross) TCM herbal prescriptions: Compatible with pharmaceutical use and work in tandem with acupuncture to re-establish healthy function of systems Instruction/education Body Awareness Regular habits: Sleeping, eating, water intake; strong messaging to eliminate caffeine and nicotine Meditation and yoga: learning self soothing and centering Movement: studies show daily exercise exceeds antidepressants for treating depression. Qi Gong teaches looking inward, developing inner resources, relaxation Bodywork: lymphatic drainage or medical massage or somatic release therapy Massage (where not contraindicated due to trauma) Enhances immunity and aids in detoxification through stimulation of lymph flow Promotes circulation and nourishes tissues Alleviates pain: headache, migraine, cervicalgia, lumbago, joint and muscle pain Lowers blood pressure and mitigates stress response Improves mood, reduces anxiety and depression 5

6 Research on the Efficacy of Massage Moyer CA, Rounds J, Hannum JW. A meta-analysis of massage therapy research. Psychological Bulletin. 130(1):3-18, A meta-analysis was conducted of 37 studies that used random assignment to test the effectiveness of massage therapy. Single applications of massage therapy reduced anxiety, blood pressure, and heart rate, but not negative mood, immediate assessment of pain, and cortisol level. Multiple applications reduced delayed assessment of pain. Reductions of trait anxiety and depression were massage therapy s largest effects, with a course of treatment providing benefits similar in magnitude to those of psychotherapy. massage/art ?pg=1 6

7 Acupuncture History National Institutes of Health, World Health Organization, international university and hospital research projects Who can practice acupuncture in California? Licensed acupuncturist (L.Ac., OMD, DAOM) MD, DO, DPM, DDS (with additional training) How it works Efficacy Safety Contraindications Benefits of Acupuncture Affordability Accessibility Frequency Diverse populations, including pregnant, incarcerated, inpatient, outpatient, still using All types of substance abuse Ease of participation Ability to develop trust Induction of relaxation, anxiety, insomnia Patient-centered care Preventative as well as corrective 7

8 How Acupuncture Works Acupuncture points are gateways through which information is exchanged. Points exhibit changes in electrical resistance in response to physiological changes, and vice versa with introduction of acupuncture needles Points known to the Chinese for thousands of years have been documented using modern electrical graphing Brewington (1994) placebo controlled studies showed dramatic effects in EEG, GSR (galvanic skin response), blood flow, breathing rate Studies link acupuncture to the production of endogenous opiate peptides (beta-endorphin, met-enkephalins) as a mechanism of reduced substance withdrawal discomfort Other neurotransmitter changes: ACTH, cortisol, serotonin, norepinephrine, 5-HPT The Function of Acupuncture in Recovery Enhance the integrity of basic life functions Establish a new baseline (homeostasis) Promote relaxation (parasympathetic response) Reduce or eliminate the need for transitional pharmaceuticals (Methadone, Suboxone ) Reduce withdrawal symptoms Improve patient compliance: Willingness to participate in therapy Ability to complete protocols 8

9 Patient s Daily Assessment of Symptoms 9

10 Published Studies Acupuncture and Electro- Therapeutics Research International Journal (1975) Omura, Smith, Wong, Apfel, Taft, Mintz, Electroacupuncture for drug addiction withdrawal Methadone-tapering program Twice daily acupuncture Reduction in cravings for alcohol and heroin Reduction in opiate withdrawal symptoms Higher program compliance The Lancet (1989): Bullock, Cullinton, Olander, Controlled Trial of Acupuncture for Severe Recidivist Alcoholism Placebo control, blinded N=80; p=<.05 >50% reduction in use over control group for six months following treatment NATIONAL ACUPUNCTURE DETOXIFICATION ASSOCIATION, INC. 10

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12 Acupuncture Safety MD Anderson review of 9 prospective studies, which included over 250,000 treatments Common side effects: Bleeding/hematoma % Pain at needling site % Fatigue % Faint/dizzy % Rare side effects <0.01%: Infection, pneumothorax, organ puncture, cardiac tamponade, broken needles 12

13 Contraindications to Acupuncture Hemophilia/bleeding disorders Cautions Bleeding risk medications (hospital): Anti-platelet: Aspirin (clopidogrel, dipyridamole) Anti-coagulant: Warfarin/Coumadin, (heparin, lovenox/enoxaparin) Suppression of acupuncture effects (slower response): Corticosteroids, Methadone, Benzodiazepines Overly tired or hungry Physical abuse/fear issues Manic/schizophrenic (supervision) TCM Theories Many Traditional Chinese Medicine theories Over 3,000 years recorded history of medical use Modern medicine crossovers: Neuroscience Psychology EM imaging studies Quantum physics Qi (energy-matter) Macrocosm/microcosm Meridian Yin-Yang (Balance) Zang Fu (Organ) Five Element Six Stages of Disease 13

14 Meridian Theory: A network of energy (Qi) flows through the body and connects points by way of different channels or meridians. These channels are related to specific internal functions. 14

15 YIN AND YANG YIN darkness water cold rest, quiet fall, winter night YANG light fire heat activity spring, summer day interior & front of body solid organs blood, body fluids produces form (material) exterior & back of body hollow organs qi, life force produces energy (immaterial) Although they are opposing stages (poles), Yin and Yang form a unity and are complementary Yang contains the seed of Yin; Yin contains the seed of Yang Yang transforms into Yin, and Yin into Yang in a constant state of dynamic balance Nothing is totally Yin or totally Yang it s all relative 15

16 The Yin Container Consequence of Abuse Injury of the Yin (water) and Yang (fire) by drug use leads to imbalance and depletion of resources This leads to the creation of an empty fire state: Tension, violence, acting out Fear, denial, shame, confusion, instability Shift in identity Weakened immune, organ and neurological function Nurturing and Quieting Holding the space : Quiet, peaceful environment No judgment or confrontation Patient builds new internal structure Helps foster a spirit of discovery or curiosity regarding feelings, thoughts, beliefs Patient does not have to change or remain abstinent to participate in treatment Yin-nurturing, restorative and pain-reducing acupuncture 16

17 Auricular Acupuncture The NADA Protocol Bilaterally: 1. Autonomic Point (SNS) 2. Shenmen 3. Kidney 4. Liver 5. Lung/Heart 2015 Warmly wishes to thank Jody James, L.Ac for being with us today. 17