Abstract
Dr. Catherine Browne has more than 20 years of experience using natural therapies for treating pain and addiction. She holds a doctorate in acupuncture and Oriental medicine and is a board-certified acupuncturist and registered professional herbalist. Here, Dr. Catherine Browne discusses emotional balancing in opioid addiction treatment.
There are three main theoretical areas that must be addressed when balancing emotions in TCM, which include: The Shen The Mind The Organs
Shen disturbance is a general term in TCM loosely referring to any psychiatric imbalance. Shen is translated as the word “spirit,” but it does not have a religious connotation in this context; rather, it is the brightness in someone's eyes, their ability to be inspired or experience awe, their general zest for life, and so on. The heart energetic organ system of TCM is very closely related to the Shen. Dullness in the eyes and outward expression of inappropriate emotions would be one of the diagnostic signs of a damaged Shen.
The Mind is called the “sea of marrow” in TCM and is closely related to the kidney energetic organ system of TCM. Opioids are toxins that damage neurotransmitters in the brain, so Chinese Medicine addresses physical brain damage with acupuncture and herbs. Thinking requires adequate spleen qi in Chinese Medicine; this only makes sense in the context of Chinese Medicine when one understands that the spleen is not the literal organ related to Western medicine, but a functional system that is more closely related to the pancreas. Realizing that the brain is reliant on glucose metabolism and supply for proper function helps to put this concept into perspective.
Furthermore, each of the five major organs of Chinese Medicine influence specific emotions common with opioid addiction when they are not in harmony:
Liver imbalances lead to anger and the typical lashing-out seen with opioid addicts, especially during withdrawal. The liver metabolizes opioids and is a natural site of long-term imbalance after opioid dependency. In addition, Liver imbalances of TCM are related to depression, which is thought to be a possible precursor to opioid medication misuse. Furthermore, the liver allows for us to have insights into the future and feel motivated. A common trait among long-term opioid users is a lack of ambition.
As already mentioned, the Spleen is associated with thinking; when negatively impacted, it is associated with overthinking, obsessive thinking, and worry. Addicts are often stuck in an endless narrative loop that emotionally entombs them in the addictive process. The Spleen is also responsible for empathy; addicts are infamous for only caring about their own needs and how they might acquire more drugs to forestall the onset of torturous withdrawal symptoms.
The Kidney energetic system of TCM is related to fear, panic attacks, and anxiety—all common emotions contributing to addiction and resulting in addiction and withdrawal.
The Lung energetic system is related to creating positive boundaries and a positive sense of self-worth; these are commonly broken down with the horrific experience of addiction and life-changing outcomes. The Lungs are related to the emotions of grief and sadness; opioid addicts often experience a great sense of grief after losing their jobs, houses, and possibly their bonds of emotional support.
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As already mentioned, the Heart is associated with all emotions, but specifically joy, or lack thereof. In addition, the heart is said to “house the mind” during sleep and is associated with insomnia and sleep disturbances during and after opioid withdrawal.
TCM is a vast subject, and the mentioned examples do not describe all of the intricacies involved with the complex theories of TCM; however, they help to lay the groundwork for a basic understanding of how acupuncture and herbs can be used in the treatment of opioid abuse disorder and recovery.
There is a broad spectrum of severity associated with opioid abuse disorder; it ranges from a patient who had surgery six weeks prior and developed a slight dependency to opioids, to a full-on addict. The treatment protocol will be determined by where the patient is situated on the spectrum of severity. Someone who has only been taking opioids for a few months would likely be able to wean off of their prescription during the course of a month with the assistance of herbs and biweekly acupuncture treatments.
A long-term opioid user, on the other hand, will require herbs and two acupuncture treatments per day for at least one week to avoid excruciating withdrawal symptoms such as muscle cramping, insomnia, emotional upheaval, intense cravings, and vomiting. After withdrawal, recovering addicts will require six months or more of regular acupuncture treatments along with tonic herbs to fully rebuild their health.
All treatment protocols and the duration of treatments are based on how the individual acupuncture patient presents and is individualized to meet his or her needs. Both acupuncture and herbs are required for all patients to achieve best outcomes, but the specific treatment approaches used in Chinese Medicine need to be assessed patient-by-patient.
Noncompliant patients: Sometimes patients who abuse opioids do not show up on a regular basis to their appointments or do not take their herbs as prescribed.
Patients with needle phobias: It is estimated that ∼10% of people in the United States have some level of needle phobia. 1 Although most of those people never end up at an acupuncturist's office in the first place, the desperation to successfully and painlessly withdraw from opioids attracts patients with a fear of needles to acupuncture. Because great concentration and focus is required for needling, it is nearly impossible for an acupuncturist to provide a great treatment to someone who is screaming the whole way through a treatment.
Nonintentioned patient: Often, family members will bring patients to me who do not desire to quit opioids, who do not like the idea of acupuncture, or are skeptical of Chinese Medicine. This situation never ends well and I do not accept patients who do not intend to work with me for successful outcomes.
It should only be attempted by fully qualified licensed acupuncturists with extensive herbal training.
Be aware that recidivism rates among opioid addicts are very high and that you may have to build a tolerance for patients who require multiple attempts for full recovery.
Family members and loved ones are under extreme stress and should be encouraged to receive treatment alongside the addict.
Full-on addicts can act aggressively and personal safety should always be a consideration.
Herbs can interact with methadone, buprenorphine, naloxone, and other medications that an addict may be taking.
Methadone and buprenorphine are highly addictive and will require a similar strategy of treatment for a symptom-free withdrawal.
The most important component practitioners must have to help their patients cultivate true healing from opioid dependency is a compassionate and nonjudgmental demeanor. In the later stages of opioid use, many patients will self-medicate with heroin after their prescriptions run out. There is a societal preconception that heroin users are the dregs of society, unworthy of our compassion or consideration. As health care professionals, we must all accept that opioid addiction is a bonafide disease, and the patients who suffer from this disease deserve our full respect. ▪