Testimony presented by Michael O. Smith, MD, DAc, to the Select
Committee on Narcotics of the US House of Representatives July 25, 1989
I am a physician and psychiatrist who has learned acupuncture on the job as Medical Director of the Substance Abuse Division, the Department of Psychiatry of Lincoln Hospital.in the South Bronx. I completed residency at Lincoln and then worked for their outpatient methadone detoxification program beginning in 1972. I remember being initially skeptical that such an apparently delicate process such as acupuncture could have a real impact on drug addiction. However, 15 years of large scale clinical experience has persuaded many of us of the popularity and effectiveness of acupuncture treatment. Currently 250 detoxification patients receive acupuncture daily at Lincoln. Our program provides acupuncture treatment in a large community room where most patients seem to be relaxing or meditating. Each day 45-50 women bring infants and small children with them to our clinic. Typically, the young mother will sit with a baby in her lap while receiving acupuncture.
Acupuncture is a foundation for psycho-social rehabilitation so that counseling, drug-free contracts, educational and employment referrals, and Narcotics Anonymous are essential parts of the program. Acupuncture not only controls withdrawal symptoms and craving, but it also reduces fears and hostilities that usually disturb drug abuse treatment settings. Acupuncture has a balancing effect on the autonomic and neurotransmitter systems as well as an apparently
rejuvenating effect. Drug abuse treatment is accomplished by inserting 3-5 acupuncture needles just under the skin or surface of the external ear. Needles are sterilized by autoclave. The
location of ear points and the technique of insertion can be taught easily so that most acupuncture components can be staffed by a wide range of substance abuse clinicians. Chapter 663 of the laws of New York State was passed in 1988 to establish that acupuncture conducted in a state approved drug treatment program will be exempt form normal licensing provided that proper
training and supervision take place.
ALLIANCE WITH CRIMINAL JUSTICE SYSTEM
In January, 1987, our clinic population was suddenly transformed by the avalanche of cocaine-based "crack" that continues to threaten our lives. We have all read about the bizarre, intractable nature of crack addiction. In professional meetings we have been told that there is no known treatment for the craving and fearful cycles of crack. From the beginning our experience at Lincoln has been strikingly different than these reports.
8,000 crack patients have been treated at Lincoln -many more patients than have been seen at any other program. Crack abusers seek treatment earlier in the course of their illness than other addicts. They often have a longer history of prior drug-free status than other abusers.
We have developed a protocol that is specifically intended to serve criminal justice clients rather than merely grafting probation and parole-referred clients onto a treatment structure designed for voluntary walk-in clients. I believe our program has had the highest success ever recorded in the treatment of an unscreened court mandate population seen on an out patient drug-free basis. More than 50% of these clients have provided negative urine toxicologies for more than two
months. We have received no adverse reports on these individuals. Certainly, the Lincoln hospital Acupuncture Program has the best record in New York City for the treatment
of court referred crack abusers.
A computerized tracking system was set up with the assistance of Dr. Stan Altman of Stony Brook (SUNY) so that any client's urine testing record could be located at a moment's notice. Lincoln tests urines for cocaine and heroin on a daily basis with EMIT system located on the premises. Therefore a probation officer, for instance, can receive a substantial, precise, and up-to-date report on any client with one phone call. This system is much more appropriate than written correspondence for the hectic and often chaotic work pattern in criminal justice service agencies. Staff members from probation, parole and family court frequently call for status
reports. They also visit the Lincoln clinic and may have a joint session with the client and Lincoln counselor on such an occasion. Our clients exhibit considerable confidence in this system which allows their frequent toxicology reports to speak for them in court.
55 clients referred by the NYC Probation Department are listed in our 1987-88 records. Most of these clients have received probation with a requirement for drug abuse treatment. Some of our most successful clients have been referred to Lincoln during the pre-sentencing probation investigation. The statistical data can be summarized in the following manner: 11 of the 55 clients (20%) attended Lincoln only once. 30 of the remaining 44 clients (68%) have responded quite well to treatment and have provided consistently negative urine toxicologies. This group of 30 successful clients has attended Lincoln for an average of 9 consecutive weeks over a span of
more than 4 months. The pre-sentencing clients were assigned to probation instead of receiving prison time. One man who was facing 30 years of federal time for drug-related charges has
been sentenced to probation because of his 6-month record of clean urines. This man still attends NA meetings here every Saturday with his 8-year old son. The judges involved have been
clearly impressed by our clients' long record of clean urines on an outpatient basis. The successful clients have been re-established. After completing the Lincoln Hospital program, clients often continue long-term drug-free recovery programs, including AA and NA.
A joint project to provide long term evaluation of Lincoln clients is being conducted by the NYC ProbationDepartment, the Police Foundation of Washington, DC and ourselves. Our plans include a properly matched controlled study with 2-year follow-up of a substantial number of clients.
In a preliminary study we have traced the outcomes of 34 clients referred to Lincoln by NYC Probation in 1978-88. Six (6) of the 34 clients (17%) attended Lincoln only once.
Eighteen (18) of the remaining 28 clients (64%) have attended more than 10 visits over a range of 2-15 months. Only one of these 18 clients has had his probation revoked and has been sent
to prison. Five (5) of the 18 clients have functioned so well on probation that they were given "early discharges" from the probation system. Five of the clients who attended less than 10 visits were re-arrested and none were given early discharge. Hence frequent attendance at Lincoln correlates with a 5:1 improvement in outcome for this series of clients.
The possibility of diverting people from incarceration is a very high priority in our field because of
overcrowding and the lack of revenue. The National Association of Criminal Justice Planners has placed a high priority of acupuncture detoxification in many jurisdictions where crack is
NATIONWIDE IMPLEMENTATION OF THIS CRIMINAL JUSTICE
In April, 1987, I was invited to Portland, Oregon by Judge Nely Johnson and a criminal justice advisor to the mayor. A pilot program was established in the public detox unit. In June the county voted to allow $60,000 of their Federal Bureau of Justice Administration funds to create several acupuncture components. Presently six new programs have been established by David Eisen of the Hooper Foundation, the county's contract agency for drug and alcohol treatment. The detoxification program now reports that 85% of its patients complete their program. Before acupuncture was used, only 34% completed the program. The 6-month recidivism rate has dropped from 25% to 6%. The Oregon State Department of Correction has helped establish a Criminal Bed Reduction Program using acupuncture to treat men charged with drug and alcohol-related offenses up to the level of class C felony. A clinic for runaway youth and a
community-based program have also been started.
State funding is earmarked for AIDS intervention IV drug treatment programs in Portland, Salem and Eugene. AIDS outreach workers will be giving out acupuncture coupons in addition to condoms and bleach. The State has suggested a Medicaid reimbursement rate of $28 per treatment with an allotment of daily treatment for 3 months and weekly treatment for a year. All clinicians will be required to be NADA-certified.
Let me quote from an independent evaluation report prepared by Carolyn Lane for Multnomah County:
"The successful post-detox enrollment rate is somewhat higher for all acupuncture participants and much higher-nearly double, or 43% versus 25% -- for participants who had 7 or more treatments. The size of the follow-up group, which is about one-third of all clients discharged form Hooper Center in a year, and the lengthy follow-up period of more than on-third
of a year, make this finding very impressive.
Our patients were asked, as part of their Acupuncture Progress Reports, to note their attendance at self-help recovery groups or their enrollment in other post-detox or recovery programs. Of those that did, about two-thirds attended Alcoholics Anonymous or Narcotics Anonymous meetings, most once or twice a week but some every day.
Without exception, the clients interviewed were enthusiastic about acupuncture. One "needed less medicine to relax, to sleep," another felt the desire to use substances "just fade away," and several remarked they were less tense, less fearful, and "able to cope with things a lot better." Another commented that "with acupuncture, you're moving toward something."
A major advantage of acupuncture is that treatment can begin immediately, while treatment programs require a client assessment, with its associated costs. The first of these is simply the fixed cost of performing a client evaluation. If the client drops out at this point, as frequently occurs with unstable individuals, the cost of evaluation plus any potential billing for treatment is lost. In addition, the loss is a source of endemic low morale among caseworkers and counselors.
Acupuncture treatment does not require such an evaluation and can begin at first contract, in many cases thus retaining clients who would not return otherwise."
In conclusion, acupuncture appears to be a very cost-effective modality in supplementing and supporting a comprehensive detoxification treatment program. Also it provides an adjunct treatment that can be applied during the entire cycle of detoxification."
Judge Herbert Klein of Miami-Dade County has spearheaded the development of an acupuncture-based program in the prison stockade and an outpatient facility in Overton. The
program which focuses on criminal justice clients began in May, 1989, and sees 100 people daily.
SUGGESTED REASONS FOR THE SUCCESS OF THIS CRIMINAL JUSTICE PROGRAM
(1) Acupuncture is a popular and effective treatment. Patients learn to have confidence in daily
acupuncture visits and the relief that consistently occurs. Acupuncture is a treatment for craving and fear as well as withdrawal symptoms. This modality facilitates constructive, non-antagonistic counseling and breaks down the barriers that usually inhibit group process. The consistently calm atmosphere in the treatment area is a marked contrast to the tense mood of streets and of even the best conventional drug program. Acupuncture acts physiologically by enhancing the patient's own
balancing mechanisms. There is a renewed development of vitality and integrity from within before external challenges need to be taken up. In this clinical setting passive aggressive dependency and adolescent acting-out are greatly reduced. Staff and patients alike can focus on stability and growth without the interpersonal static that usually limits communication.
(2) We have applied many of the basic principles of chemical dependency which are often neglected in criminal justice related situations. The struggle for sobriety is "one day at a time." By testing urines on a daily basis, providing daily acupuncture, and encouraging brief daily counseling sessions -- we are functioning in the same rhythm as the patient's struggle for recovery. Testing urines every two weeks, in contrast, functions as an external judgmental process that clashes with the potential rhythm of recovery. A common principle of AA is "keep is simple."