Substance Abuse and Dependence Health Article

Alternative treatment

The efficacy of alternative treatments for substance use disorders remains for the most part ambiguous. One treatment that has been recently shown to have variable success is the use of acupuncture in treating substance dependence. In 2000, a randomized controlled trial of the effect of acupuncture on cocaine addiction reported that acupuncture significantly reduced the cocaine use of study participants. A 1999 meta-analysis (summary analysis of studies), however, reported that acupuncture had no statistically significant effect on smoking cessation.

There has been movement towards examining some of the (anecdotally) promising treatments in more rigorous clinical trials. In particular, there has been some interest in Pueraria lobata, or kudzu, an herb that has reputedly been used in Chinese medicine to treat alcoholism. Preclinical trials of an herbal formula with kudzu have shown that increased consumption of the herbal formula is associated with decreased consumption of alcohol. Toxicity studies show few ill effects of the formula, and human trials are currently being undertaken to more fully evaluate the efficacy of this treatment.

The effectiveness of electroacupuncture (the practice of acupuncture accompanied by the application of low levels of electrical current at acupuncture points) in alleviating opiate withdrawal symptoms is also being examined. Preclinical trials suggest that electroacupuncture treatment given prior to the administration of naxolone (a medication that counteracts the effects of opiates but precipitates withdrawal symptoms) seems to to alleviate the withdrawal effects of naxolone.

Prognosis

Recovery from substance use is notoriously difficult, even with exceptional treatment resources. Although relapse rates are difficult to accurately obtain, the NIAAA cites evidence that 90% of alcohol dependent users experience at least one relapse within the 4 years after treatment. Relapse rates for heroin and nicotine users are believed to be similar. Certain pharmacological treatments, however, have been shown to reduce relapse rates.

Relapses are most likely to occur within the first 12 months of having discontinued substance use. Triggers for relapses can include any number of life stresses (problems on the job or in the marriage, loss of a relationship, death of a loved one, financial stresses), in addition to seemingly mundane exposure to a place or an acquaintance associated with previous substance use.

The development of adaptive life skills and on-going drug-free social support are believed to be two important factors in avoiding relapse. The effect of the support group Alcoholics Anonymous has been intensively studied, and a 1996 meta-analysis noted that long-term sobriety appears to be positively related to Alcoholics Anonymous attendance and involvement. Support for family members in addition to support for the individual in recovery is also important. Because substance dependence has a serious impact on family functioning, and because family members may inadvertently maintain behaviors that initially led to the substance dependence, on-going therapy and support for family members should not be neglected.

Prevention

Prevention is best aimed at teenagers and young adults aged 18–24 who are at very high risk for substance experimentation. Prevention programs should include an education component that outlines the risks and consequences of substance use and a training component that gives advice on how to resist peer pressure to use drugs.

Furthermore, prevention programs should work to identify and target children who are at relatively higher risk for substance abuse. This group includes victims of physical or sexual abuse, children of parents who have a history of substance abuse, and children with poor school performance and/or attention deficit disorder. These children may require more intensive intervention.

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed., text revision. Washington, DC: American Psychiatric Association, 2000.

American Psychiatric Association. DMS-IV Sourcebook. Vol. 1. Washington, DC: American Psychiatric Association, 1994.

PERIODICALS

Rivara, F., et al. "Alcohol and Illicit Drug Abuse and the Risk of Violent Death in the Home." Journal of the American Medical Association 278 (20 August 1997): 569+.

Schneider, Robert K., James L. Levenson, and Sidney H. Schnoll. "Update in Addiction Medicine." Annals of Internal Medicine 134 (March 6, 2001): 387-395.

ORGANIZATION

Alcoholics Anonymous. Grand Central Station, P.O. Box 459, New York, NY 10163. (212) 870-3400. <http://www.alcoholics-anonymous.org>.

Al-Anon Family Group Headquarters, Inc. 1600 Corporate anding Parkway, Virginia Beach, VA 23454. (757) 563-1600. <http://www.al-anon.alateen.org>.

National Clearinghouse for Alcohol and Drug Information. 11426-28 Rockville Pike, Suite 200, Rockville, MD 20852. (800) 729-6686. <http://www.health.org>.

National Institute on Alcohol Abuse and Alcoholism (NIAAA). 6000 Executive Boulevard, Willco Building, Bethesda, MD 20892-7003. (301) 443-3860. <http://www.niaaa.nih.gov>.

OTHER

American Psychiatric Association. "Practice Guidelines for the Treatment of Patients with Substance Use Disorders." Washington, DC: American Psychiatric Association, 1995.

Genevieve Pham-Kanter