NADA Protocol for addiction treatment in India- In retrospect

 

Suneel Vatsyayan, MSW, ADS, Nada India Dr. Ajay Vats, PGDACP, ADS, Indian

Association of Acupuncture Detoxification Specialist

National Survey on Extent, Patterns & Trends Drug Abuse in India: 2004

Sample Size 40,697 males(12-60 year)

Prevalence of current useAlcohol 21% Cannabis 3% Opiates .7% Poly drug users 22.3%IDU (ever) .1%

Name Prevalence Dependency Volume

Alcohol 62.5m 16.8% 10.5m

Cannabis 8.7m 25.7% 2.3m

Opiates 2.0m 22.3% .5m

Treatment resources available are not commensurate with the 'burden

of work• The survey not only points to the

problem of India's population having twice the global (and Asian) average prevalence of opiate consumption, but also shows that the treatment resources available are not commensurate with the 'burden of work' (number of dependent drug users).

The Bio-Psycho-Social Perspective of Drug Abuse

“Health is a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity reflects the holistic view of health most widely accepted today. Even drug abuse can be considered within this model, as it is a bio-psycho-social problem.” - WHO

Manifestations of Drug Addiction

• Irresistible urge for drug• Lack of self control• Change in daily routine of

activities - neglect of personal appearance & hygiene

• Moody - often subject to extreme of temper

• Guilt feeling• Lack of self confidence and

self image

• Inability to take decisions• Lack of objective perception• Feeling of loneliness and

apathy• Distortion of interpersonal

relationships• Association with addict friends• Deterioration of work

performance• Propensity for illegal activities

Treatment Components

• Detoxification• Treat Withdrawal• Prevent Complications• Correct/Treat Damage Done

– Usually done in hospitals / specialized setting and using medicines.

• Psychotherapy & Counselling• Individual Therapy• Family Therapy• Group Therapy with recovering addicts; as in AA, NA• Craving Control Techniques• Behavioral Therapies• Relaxation and Leisure Time

Rehabilitation & After care

Rehabilitation

• Whole person recovery• Commitment to a drug free life• Acceptance of higher value• Adaptation to work and responsibilities• Social re-integration• ‘De-addiction’

Usually done in a specialized facility.

Rehabilitation & After care

Aftercare

A process designed to maintain the gains made in treatment and rehabilitation• Offers opportunity to address outstanding issues• Provides safe environment until support is no longer required.• Review of treatment gains• Identifying and handling craving• New roles and responsibilities• Healthy social activities• Non drug using peers and friends• Solid counselling relationships• Share to enable care

May be in out-patient setting through communication and self help groups/ ex-addicts/ volunteers/ professionals.

The needs and challenges in the field of addiction treatment in India

• Demand reduction strategies seek to prevent the onset of drug use, help drug users break the habit and provide treatment through rehabilitation and social reintegration.

• A gap between the streets or ‘natural settings’ associated with drug use or the outreach worker and the threshold of the drug treatment program where the drug user is expected to arrive committed, ready or interested in quitting drugs

• Drug treatment that is limited to abstinence and acceptance of the addict identity has excluded the majority of drug users who are not ready or interested in quitting drugs or taking on this identity or disease.

Change is process

‘I have a problem’ or ‘I think I should quit’ or ‘I have to do something about this…

Mixed feeling of ambivalence to commitment for treatment is long journey… and relapses are part of it.

Challenges

• Can we treat a client before assessment and diagnosis are completed so that the client can be calm and cooperative enough for a useful diagnosis to be made.

• Confronting about drug use is necessary?

• Can we help a client even while they are in denial about the need for treatment.

• Can we make a client relax without him losing control.

• Is the treatment to which client may return at any time, especially following a relapse and still find all the benefits

Acupuncture does not confront the person..

• Dr. Michael Smith has noted that a verbal exchange is not required, nor is a readiness to talk with counselors or a willingness to complete an assessment or fill out a form.

• NADA acupuncture adds a valuable component

to the correction ,rehabilitation and behavioral health field without any extra cost.

Non verbal…non threatening

Acupuncture is usually non-threatening because it is non-verbal—the person does not have to explain or justify himself and it does not have to be associated with labeling or diagnosis, or an expectation that the person be interested in abstinence, much less drug or alcohol free at the time they are treated.

Acupuncture is useful because it doesn’t revolve around the drug

• The acupuncture allows greater flexibility in treatment approaches because the worker can step out of the expert role because the approach itself models a more horizontal relationship: ‘Did you swab your ears and are you ready for a treatment?’

• Acupuncture and all Qi-flow therapies “help the body help itself.” Some of us have come to appreciate the body’s spontaneous healing potential.

NADA Protocol

At three to five designated ear points in each auricle (outer ear), clinicians trained through NADA apply fine gauge, sterilized, one-time use stainless steel needles just under the skin, where they remain for up to an hour while the client (in most circumstances) relaxes quietly in a comfortable chair. Ordinarily, groups of clients sit together while undergoing the treatment.

NADA Protocol

The procedure functions as an adjunct to a comprehensive treatment program offering the basic therapeutic elements of counseling, education, family involvement, mutual support group involvement, supportive health care of general nature.

Benefits of NADA points• Sympathetic is related to disruption in both sympathetic and

parasympathetic nervous systems; it has a strong analgesic and relaxant effect on internal organs as it dilates blood vessels.

• Shen Men regulates excitation and inhibition of the cerebral cortex and can produce sedation; it is used for many neuropsychiatric disorders.

• Lung is used for analgesia, sweating, and various respiratory conditions.

NADA Points

• Liver addresses symptoms associated with poor liver functioning, neuralgia, muscle spasms and inflammation

• Kidney is the strengthening point for cerebellum, hematopoietic system; the kidneys and can relieve mental weariness, fatigue and headaches.

The NADA model of recovery

“Not just “giving it away”, but empowering communities to be self-reliant.”

“If you know something and you know it first, it has no meaning unless you let go so someone else knows it...” - Michael O. Smith

NADA acupuncture may help facilitate significant reduction in cravings, depression, anxiety, anger, body aches/headaches, concentration, and decreased energy. (Kenneth, et. al.)

NADA Model

Nada in India since 1999

In 1999, NADA protocol was introduced in India under the supervision of Dr. Michael O. Smith with the objective of making barrier free services and well-being issues available across communities.

NADA policies help the acupuncture profession

• Upgraded role and new income for acupuncturists as supervisors, trainers and conveners (New Income)

• NADA programs refer appropriate patients to full body acupuncturists (More patients)

• NADA provides people in general- an opportunity to overcome fear of needles before he/she approaches acupuncturist… (Higher acceptability of needle)

• NADA engages a people before he commits or ready for new identity of a “Patient” (Trust building)

• NADA gives a chance to experience well being

ADS = Safe Track record

• American Acupuncture Council: No claims ever filed against ADSes

• Comparison of Acupuncturists and ADSes in New Mexico

• 14 = # Complaints filed against full body acupuncturists 2008 – 2010

• 0 = # Complaints filed against ADSes 2006 -2010

• No verified information available prior to these dates; Source: New Mexico State Board of Acupuncture and Oriental Medicine

Initiating NADA policies

• Allowing NADA outside of the treatment of addictions

• Creating inroads for non-professional allied health workers & nurses as assistants and helping professionals like social workers, counselors, psychologists as Acupuncture detoxification associates

• Allowing clinics and self help groups that are registered NGO as to provide services

Thanks

www.acudetoxindia.com www.nadaindia.info www.acudetox.com