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Auricular Acupuncture and Addiction: Mechanisms, methodology and practice
  1. Colin Lewis
  1. aim.bmj.com

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Kim Wagner, Sue Cox. Published by Churchill Livingstone; 1 edition (1 October 2008) 256 pages, £31.99 (paperback) 978-0443068850

The book opens by reminding the reader that acupuncture is not a cure for addiction but reduces the symptoms and cravings of addiction by supporting other treatments. The authors claim the book to be their SMART (Substance Misuse Academy Registered Training UK) course textbook and also that SMART UK is the provider of choice having trained 5000 in the use of acupuncture.

The basics of the nervous system are well explained (“neurons scream their heads off when they get excited”) and the text builds on this to explain the types of neurotransmitters focusing on the pleasure, anticipation and satisfaction generated by dopamine release, and the modulation by serotonin. Throw this at the limbic system and the hypothalamus, add in a genetic predisposition and the addict is born. The drugs of misuse and their clinical pharmacology are very well described with fascinating quips like “cocaine is 1000 times better than sex”.

Following a very readable, logical and scientific start to the book, we get to Qi and the muddled interplay of Traditional Chinese Acupuncture and scientific evidence resulting in “no scientific proof for the existence of any mystical ‘life energy’”. Precisely. So the authors’ new model for Qi energy remains unconvincing. No book on Traditional Chinese Acupuncture seems complete without reference to Yin and Yang, so here is how it works: pop a needle into the ear which will stimulate the raphe nuclei and release serotonin (Yin) which reduces pain through its action on nociceptors, with concomitant release of endorphins (also Yin) which solves everything! Who needs Yin and Yang as explanation?

There must be more to auricular acupuncture than this. The penultimate chapter, at last, briefly discusses some auricular acupuncture mechanisms. The contribution by Paul Nogier is dispensed with in half a page, as is Wen’s work in 1973 (the neurosurgeon who found by chance that electroacupuncture to the ear cured some heroin and opium addicts), and Smith’s research in 1982 showing a 90% relief of symptoms with acupuncture, makes up most of the history of ear acupuncture in the book. So what’s left? SMART of course! Only not a lot is said about the actual technique. The points used are not defined or illustrated. In fact there is nothing to guide you as to where to insert the needles. Not even mention of the highly successful National Acupuncture Detoxification Association regime in which five standard ear points are used with any addiction with good results. You would think, the use of ear acupuncture to help smokers kick the habit, would be described in detail — but hardly a mention. This book is definitely not a practical manual on any form of acupuncture. The book concludes with a chapter on a small trial of ear acupuncture on male prisoners which showed no differences between the control and treated group apart from improved wellbeing in the active treatment group. Good research was lacking.

I felt a sense of disappointment after reading the book. The practical application of auricular acupuncture was not covered: you would obtain this from a dedicated text on ear acupuncture in a chapter devoted to the withdrawal of habituating substances. If you are not too worried about the lack of acupuncture technique then this is a highly readable introduction to the psycho-pharmacology of drug addiction.

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