By Lianne Audette

When you think of addiction, what comes to mind? Alcoholism? Injectingheroin? Smoking crack? Alcoholics Anonymous? All true and accurate depictions, but they are just a wee twig of a large tree with enormous, twisty roots. What about video gaming, running, shopping, smoking, sex, eating, gambling, obsessive thinking, compulsive behaviors, hating, despairing, wanting? Do you know that there are 12-step programs for all of the issues above, and more programs springing up all the time? Think about the chronic conditions that many of our patients suffer from, such as anxiety, depression, insomnia, chronic pain, and fatigue. Left to their own devices and desperate to medicate themselves, many people will turn to addictive substances. Some will be bought on the street and some prescribed by their physician. Too often pharmaceuticals are prescribed over and over again, often with little success and with little or no follow up, until the patient is well into the downward spiral of addiction. And, sad to say, the cause of the problem remains untreated.

The medical definition of addiction is: "... a chronic, progressing and relapsing brain disease that is characterized by a compulsive drug seeking and use, despite harmful and/ or lethal consequences. It is considered a brain disease because drugs (and "medicating" behaviors) change that organ's structure and manner of function." These brain changes can be long lasting and lead to the destructive behavior typically seen in people who abuse drugs. The disease of addiction affects brain and behavior, and scientists have identified many of the biological and environmental factors that contribute to the development and progression of the disease. "The pejorative term ‘abuse,' used in connection with diseases of addiction has the adverse effect of increasing social stigma and personal shame, both of which are so often barriers to an individual's decision to seek treatment." (Source: Recognizing Addiction as a Disease Act of 2007, S1101 IS, " a revised definition by Sen. Joe Biden who is working to implement language reform to do away with the old (normal) language which contains a concealed evil.... being that the addicted person is a bad person who does a bad thing.)

Consider this: An upstanding person suffers from chronic pain and has not yet tried acupuncture, nor has his physician recommended such treatment. Instead the person is prescribed hydrocodone (Vicodin) or oxycodone (Oxycontin); both of which are fast acting, effective, and highly addictive. Another scenario might be the insomniac who suffers from anxiety. They are exhausted and cannot keep their mind focused. The doctor prescribes zolipedem(Ambien) or alazopram(Xanax). These drugs are considered safe and effective by the Western medical establishment; and both are known to be habit forming and addictive, when taken excessively or for a prolonged time. But the nature of mood and mind-altering substances, combined with our American "more is better" mindset, is almost a guarantee that these substances will be used inappropriately and dependence will occur. Sometimes, the patient will not admit to their doctor that they are taking more than prescribed and will seek other doctors for new prescriptions and, eventually, will resort to acquiring the drugs from a "street vendor," so to speak. A dangerous and potentially hopeless situation is in progress for this kind of patient. Countless examples exist of these kinds of paradoxical traps and they ensnare regular people every day. The good news is that we, as acupuncturists, can work the most effective wonders when we look at these conditions from a TCM point of view.

As an acupuncturist specializing in addiction treatment for the last 20 years, I firmly believe that many of patients' everyday complaints already qualify as addictions, or are well on the way. Ask yourself: are most of your patients seriously sick with life threatening, debilitating disease or, rather, simply unwell, uncomfortable, or not fully functioning with zest and joy? Are they tired, distracted, pain-ridden, anxious with racing thoughts, poor memory and concentration, depressed, suffering from over or under active digestion? Historically, doctors prescribed opium or alcohol for such serious symptoms as the "jitters" (anxiety and tension), a jumpy stomach (indigestion), the "trots" (diarrhea). Various mental humors of all types were treated with narcotics.

Not much has changed in the medical model except for the blessing of Big Pharma and the FDA. Revisit the medical definition for addiction. This time as you read it, substitute "imbalance" for "brain disease" with imbalance of Yin and Yang. Too much Yang? Not enough Yin? We also recognize syndromes, which can lead to addiction such as arrogant liver, heart yin deficiency or fire, kidney yin deficiency, lung qi deficiency, spleen deficiency, liver overacting on other yin organs. These disharmonies can result in insomnia, a racing mind, anger and irritability, pain, anxiety, compulsive/obsessive behaviors and depression, to name but a few. All of these disorders fall into the category of addictive disorders. Granted, this sounds simplistic...but when you think of brain diseases, you really are looking at a root or causal situation. When we differentially diagnose with TCM, we must look at the root also, which would be Yin or Yang and out of harmony with each other.

As acupuncturists, we are well equipped to successfully treat these everyday symptoms. Substance consumption and/or obsessive types of behavior fit lock and key with our TCM model of addiction. Yes, these afflictions can be complex and sometimes unremitting, but apply the Eight Principles to these conditions and the picture will become clearer. Then add on the aspect of "empty fire" consuming Yin as the syndromes escalate due to progression of the causes of Yin deficiency: poor diet, lack of exercise, stress, overwork, etc, and you will start to see a picture emerge. A picture of a client who is ramping down into a chronic, progressive condition which can either become a debilitating affliction or will require the use of drugs (addictive) or both. Haven't you observed the alienation and isolation and despair, which accompany a person who suffers from addiction to alcohol, eating, smoking? These feelings also deplete Yin and propagate the syndromes of deficiencies, which often only an outside substance or behavior will satisfy.

Hence, the addiction treatment model from a TCM standpoint. We have people who are underperforming, often not meeting their obligations, probably not in rewarding relationships either at work, home or out in the world, and feeling sick. Our assessment must be simple, and treatment must work immediately, and very importantly, be affordable and accessible.

The emerging model of community style acupuncture is well on the way to becoming a major model for delivering acupuncture treatment, as it recognizes the needs of the majority of our population. The auricular method of treatment is most often the way treatment is planned and delivered, and the problems of money and time are successfully addressed. Group settings are great at putting people back into the community, particularly if it is a community full of people with a common purpose: recovery.

Since Pacific College of Oriental Medicine San Diego's door swung open, recovery has been the whole point (pun definitely intended). So unsurprisingly, Pacific has been a frontrunner in establishing clinics where acupuncture is used to guide people off the dead-end path of addiction towards good health and productivity. While the college still maintains their busy teaching clinic for all manner of conditions and concerns, the last ten years have seen a trend outward into the community, especially for addiction treatment. Pacific's interns have had clinical exposure to the community health setting for years via the school's affiliation with the UCSD Free Clinics Project. The Project has two locations, one downtown and one in Pacific Beach, both busy clinics for the Homeless and the underserved. They are staffed by UCSD medical students, volunteer UCSD staff physicians and Pacific College interns.

In keeping with their high standard of excellence, the college added addiction treatment to the curriculum. Classes provide expert exposure to the field of addiction and public health models. But recent efforts to increase community involvement and focus on the specific needs of the population have resulted in Pacific's collaboration with hospitals, existing public health agencies, and community service organizations. In the last few years, students have received practical, hands-on experience in treating addiction across a wide swath of possible patient populations.

Family Recover Center in Oceanside is a member of Mental Health Systems, Inc the largest provider of public mental health-recovery services in San Diego County is one such site. Living here are 45 mothers undergoing treatment for addiction and their, roughly, 30 children of all ages below 11 years. The treatment program is intense and stress is high, made all the more so, given that successful recovery is the only way to remain united with their children. Acupuncture treatment here is an adjunct to the comprehensive program, allowing students to address anything and everything that the women (and their children) may need. Community style acupuncture, NADA treatment, body therapy and private one to- one sessions are all utilized.

Pacific's affiliation with Rady Children's Hospital, San Diego provides interns the opportunity to treat addiction or prevent the development of addiction in the kids, themselves. Acupuncture has become a critical tool in treating children with chronic pain disorders who, at minimum, are high risk for developing addiction. Treatment at this location is used both to wean already narcotic dependent kids off the dangerous medication, and reduce the need for narcotics altogether.

 Though not as well known to the public, one of the more commonly treated addict populations is comprised of people with psychiatric illness. Pacific's alliance with the Telecare Corporation's Access Program San Diego is yet another venue for the College's interns to gain experience and witness the wonders of acupuncture treatment even for complex, "dual-diagnosis" patients such as these.

Given the highly specialized focus of the aforementioned facilities, Pacific also works with "regular" community service organizations who offer a traditional array of medical and social supports. Acupuncture is being integrated with great ease at: City Heights Wellness Center, Tubman- Chavez Multicultural Center Hoover High School in association with Alternative Healing Network.

LIANNE AUDETTE is a licensed acupuncturist in California, and has been integrating acupuncture into drug and alcohol treatment settings for the past 13 years. These settings

have included homeless shelters, half-way houses, drop-in centers, day and residential treatment, out-patient, mental health and drug court. Additionally, she is consultant to the Betty Ford Center and the Nat'l Assn. of Drug Court Professionals. Audette is a Registered Trainer for the National Acupuncture Detoxification Association (NADA). As such, she offers seminars for drug and alcohol treatment professionals about acupuncture and Chinese medicine; similarly she educates acupuncturists about chemical dependency. In addition to acupuncture curriculum, Audette presents recent findings on the role of nutrition as part of the key to restoring mental health and eliminating addictive behaviors.

Currently Audette practices complimentary medicine, integrating her knowledge of Western medical differential diagnosis and treatment with the principles and practices of TCM. She holds a Bachelor's degree in Clinical Nutrition, is a Naturopathic physician, and is nationally certified to practice acupuncture. She travels around the US and internationally, giving NADA trainings and lecturing on Acupuncture for the Treatment of Addictive Disorders. Audette will be delivering a Plenary presentation at the Community Addiction Recovery Association Conference, April 17-19, 2009 at the Hilton Arden West in Sacramento, CA titled Brain Repair for Addictive Disorders: Cost-Effective, Successful, and Drug-Free Therapies.