Substance Use & Related Disorders

Addressing issues related to addictive behaviors and diagnoses

Complementary Alternative and Integrative

Treatment for Substance Use Disorders
ABSTRACT
Complementary alternative and
integrative medicine (CAIM) modali-
ties are increasingly sought after by
patients with chronic health condi-
tions such as substance use disorders
(SUDs). Evidence suggests that CAIM
interventions can improve symptoms
commonly seen in patients with SUDs,
such as stress, anxiety, depression,
and pain. Mindfulness-based inter-
vention (MBI), such as meditation,
has proven effective for a variety of
conditions, including SUDs. Other

© 2018 Adobe [Link]

CAIM strategies, such as manipulative
body practices and healing energy
medicine techniques, are also show-

T
raditional or conventional not available (Schuckit, 2016). When
ing some evidence of effectiveness.
evidence-based medicine conventional therapies are ineffective
These methods center on the concept and therapeutic approaches or fail to fully treat a disorder, practices
of restoring balance to energy fields for treating substance use disorders that fall outside the mainstream can be
or acupoints on the body, including (SUDs) are somewhat limited in num- used in addition to conventional medi-
ber, and exacerbation or relapse rates cine, which is described as integra-
chakras and meridians. Nurses are in remain similar to other chronic disor- tive or alternative medicine (Gerbarg,
an ideal position to educate, admin- ders at 40% to 60% (National Institute Muskin, & Brown, 2017).
ister, and teach patients these CAIM on Drug Abuse, 2014). An additional Initially, the National Institutes of
methods to integrate with traditional challenge in treating SUDs is the high Health center for nonpharmacological
rate of co-occurring mental health therapies was named the Office of Alter-
medical care. Resources to learn CAIM disorders, including depression, anxi- native Therapy, but has been changed to
methods can be accessed online, and ety, and posttraumatic stress disorder the National Center for Complementary
specialized certification in this field is (PTSD) (Substance Abuse and Men- and Integrative Health (NCCIH; 2015,
tal Health Services Administration, 2016). Terminology surrounding these
also available. [Journal of Psychosocial
2017). Pain is also a common symp- nonconventional treatments varies, but
Nursing and Mental Health Services, tom in patients with SUDs during the the term complementary alternative
56(6), 16-21.] withdrawal period when substances are and integrative medicine (CAIM) is

Gail Van Kanegan, DNP, FNP-BC, APHN-BC, EEM-AP; and

Julie Worley, PhD, FNP-BC, PMHNP-BC, CARN-AP

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 Substance Use & Related Disorders

often used and is reflective of the prac- changes and stress reduction (Taren The concept of chakras originated in
tices as a whole (Gerbarg et al., 2017). et al., 2015). Systematic literature re- India, and they are thought to be en-
Categories of CAIM modalities include views have shown that MBIs can re- ergy channels and centers within the
dietary supplements, such as a variety duce the consumption and cravings of body that can be interacted with to
of micronutrients and plant-based or several substances, including alcohol, promote balance (Rostami & Jaami,
herbal medicines; however, the current cocaine, amphetamine drugs, mari- 2016; Viswanathan & Pinto, 2015).
article focuses on mind–body medicine, juana, cigarettes, and opiate agents, The word chakra comes from the
manipulative body practices, and energy and restore natural reward processes Indian Hindu language of Sanskrit
therapies that can be used in the treat- (Chiesa & Serretti, 2014; Garland, (Thompson, 2016), and means wheel,
ment of SUDs (Gerbarg et al., 2017). Froeliger, & Howard, 2014). referring to the seven main energy
centers that must be in balance to
MIND–BODY MEDICINE MANIPULATIVE BODY PRACTICE regulate the flow of energy to promote
The best known CAIM modalities AND HEALING ENERGY healing (Rostami & Jaami, 2016;
used for a variety of conditions, in- PHYSIOLOGY Viswanathan & Pinto, 2015).
cluding SUDs, are mind–body inter- Healing energy and healing medicine
ventions (MBIs), such as meditation. are broad terms used for CAIM tech- Acupressure
Specific strategies of mindful medita- niques that work with the body’s sub- Acupressure is a CAIM modal-
tion include concentration on or rep- tle energies for realigning, clearing, ity similar to acupuncture, a technique
etition of a word to quiet the mind, and delivering fresh energy for heal- where needles are inserted into the me-
and concentrating on thoughts and ing and vitality (Feinstein & Eden, ridian acupoints, which are each num-
emotions in the present to reduce neg-
ative thoughts and emotions, which
can activate an innate capacity for
healing (Black, 2014; Montgomery-
Dossey & Keegan, 2016; Weerasinghe Strategies of manipulative body and healing
& Bartone, 2016). Mindfulness-based
meditation can be described as a com- energy practices focus on interacting with fields
plex process of disciplinary systematic within the body that are thought to promote
training and deployment of attention
and awareness, which has been shown wellness, including meridians and chakras.
to reduce negative thoughts and emo-
tions and substance use relapse (Black,
2014; Weerasinghe & Bartone, 2016).
Four elements common in meditation
include (a) a quiet location with few 2008; Warber, Bruyere, Weintrub, & bered to correspond with a body region
distractions; (b) a comfortable pos- Dieppe, 2015). Strategies of manipu- to stimulate energy flow (Longhurst,
ture; (c) focus of attention on a cho- lative body and healing energy prac- 2010; Zhou & Benharash, 2014). In
sen word or set of words, an object, tices focus on interacting with fields acupressure, those same meridians are
or the sensations of the breath; and within the body that are thought to stimulated by applying firm yet gentle
(d) an open attitude of letting distrac- promote wellness, including merid- pressure to the acupoint by the use of
tions come and go without judging ians and chakras. Meridians are energy fingers or a blunt object to stimulate
them (NCCIH, 2016). Improvement pathways that connect to the sympa- energy flow (Adams, Eschman, & Ge,
in brain function from MBIs has been thetic and parasympathetic nervous 2017; Eden, 2008; Mangione, Swen-
documented, including an increase in system and regulate physiological gros, & Anderson, 2017; Micozzi,
grey matter concentrations in brain function and balance (Au et al., 2015; 2015). When illness, disease, pain, or
regions involved in learning, mem- Thie & Thie, 2012). There are 12 ma- physical dysfunction are present, the
ory, self-referral processing, emotion jor meridians that supply organs with energetic flow through meridians can
regulation, and perspective (Hölzel body energy flows (Micozzi, 2015). be disrupted. By application of manual
et al., 2011). In addition, it has been Each meridian energy pathway has a pressure and stimulation of acupoints,
found that MBIs increase white mat- number of different energy points that the energetic balance can be restored
ter connectivity (Laneri et al., 2016) are recognized as acupoints, which, through the meridian, thereby to the
and decrease the amygdala size, which when stimulated, can improve ener- body part it serves (Micozzi, 2015;
can promote positive neuroplastic getic flow (Zhou & Benharash, 2014). Wagner, 2015). Acupressure applied

JOURNAL OF PSYCHOSOCIAL NURSING • VOL. 56, NO. 6, 2018 17

Substance Use & Related Disorders

Porter, & Whitty, 2012). Methods in

EFT are easy to learn and can be ap-
plied to a variety of situations by tap-
ping on the same meridians used in
acupressure while stating the problem
that is experienced, such as anxiety,
and the desired outcome of freedom
from that problem.

©2011 Innersource Healing Touch

Figure. Meridian acupressure sites for triple warmer (TW) relaxation (Eden, 2008; Thie & Healing Touch (HT) uses the hands
Thie, 2012). and intention to work with what are
Note. ST = stomach; UB = urinary bladder. thought to be subtle energy fields that
Reprinted with permission from Innersource. promote healing and relaxation when
balanced (Foley, Anderson, Mallea,
to specific acupoints along the merid- reported positive effects of acupressure Morrison, & Downey, 2016). In HT,
ian for a specific length of time is easily treatments in the relief of anxiety (Au one person places his/her hands over
learned and can be done for self-care, et al., 2015). Other researchers studied another person with or without making
administered to the patient in the of- the National Acupuncture Detoxifica- contact for 5 to 60 minutes as a way of
fice or hospital bed. One of the most tion Association protocol, which in- clearing stagnant energy and delivering
useful acupressure maneuvers for re- cluded acupressure in a substance abuse healing energy, which has been shown
duction of stress and anxiety reactions treatment program (Carter, Olshan- in some studies to decrease stress, anxi-
is to manipulate a meridian referred to Perlmutter, Marx, Martini, & Cairns, ety, and pain (Goldberg et al., 2016;
as the triple warmer (also referred to as 2017). Ear acupressure points were Hendricks & Wallace, 2017). In some
triple burner), which is thought to be stimulated in participants during their cases, HT strategies can be performed
related to aid in metabolizing fluids in recovery. Study results demonstrated by oneself. Several HT strategies exist,
the body (Cutler, 2007). Methods for positive outcomes of participants feel- including holding hands still or mak-
acupressure to the triple warmer merid- ing better about themselves as well as ing movements above the body over
ian for relaxation include holding the improved energy levels and less body chakras and performing subtle energy
specific triple warmer meridian and aches. Of those who received acupres- clearing by making sweeping or comb-
other acupoints at the same time on sure, there were more individuals who ing movements over the body from
one side of the body with one or two completed the rehabilitation program head to toe (Foley et al., 2016). Other
fingers for 3 minutes, repeating the and a higher incidence of abstinence strategies for reducing pain include
same on the opposite side of the body. from alcohol at 3- and 6-month follow the pain drain technique, which en-
Meridian acupoints commonly ma- up (Carter et al., 2017). tails placing the left hand over an area
nipulated are triple warmer #10 with of pain with the right hand initially
stomach #36 and triple warmer #2 with Emotional Freedom Technique placed downward to the earth to drain
urinary bladder #66 (Eden, 2008; Thie Another meridian manipulation painful energy. When the pain is re-
& Thie, 2012) (Figure). method is manually applying intermit- leased, the left hand is turned upward,
Although not in abundance, some tent pressure to meridian points through and the right hand infuses the painful
studies have evaluated the effectiveness tapping on them with the fingertips, area with healing energy (Foley et al.,
of acupressure. In one study on auricu- which is a method in the Emotional 2016). In the pain ridge technique,
lar acupressure in patients with SUDs, Freedom Technique (EFT) (Church hands are passed above the individual’s
researchers found that it resulted in a & Feinstein, 2017). In EFT, tapping body in sweeping motions over an area
significant decline in the severity of on meridians is done while experienc- to reduce pain (Foley et al., 2016).
cravings, psychological distress, and ing a distressing emotion or thought,
drug/alcohol measures (Tian & Krish- which is an exposure component. Use Eden Energy
nan, 2006). In another study, a meta- of EFT has been shown to improve out- Eden Energy Medicine is an orga-
analysis of randomized controlled trials comes in treatment of SUDs, food crav- nization started by Donna Eden, who
between 1997 and 2014 was performed ings, depression, PTSD, and anxiety is self-taught and has been a practitio-
comparing acupressure with sham con- (Church & Brooks, 2013; Church & ner of CAIM for more than 30 years
trol (Au et al., 2015). Of the studies Feinstein, 2017; Clond, 2016; Gaesser (Innersource, 2017). Eden (1998)
that met criteria for meta-analysis, all & Karan, 2017; Stapleton, Sheldon, authored the best-selling book Energy

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 Substance Use & Related Disorders

TABLE 1
QUICK ENERGY EXERCISES TO RELIEVE STRESS AND ANXIETY AND REMOVE NEGATIVE ENERGY
Situation Action to Take
To relieve stress, anxiety, panic attacks: Put index fingers and thumbs together and make the “OK”
Mellow Mudra sign sign. Place fingers and thumbs at each temple. Lay remaining
3 fingers across forehead lightly and hold. Take deep breaths
in through nose and out through mouth for 1 to 5 minutes, or
until anxiousness has passed.
To keep negativity out of one’s aura: Hook up energies: Place middle finger in navel and other
When faced with a difficult patient or situation; before middle finger between eyes on forehead. Push in and up, take
entering an uncomfortable place or crowd a few deep breaths in through nose and out through mouth.
Acupoints: Thump kidney meridian on each side of chest just
below clavicle five times; then make fist and thump center of
sternum, place hands along sides of bottom of ribs and thump
or rub deeply.
Zip-Up: Trace central meridian from pubic bone up center of
body to top of bottom lip.
To calm stress reaction: With one hand to opposite side, start at temples and trace
Trace triple warmer backwards to reduce the excess energy it over and behind ears, to shoulder, and down outside of arm to
carries tip of ring finger. Do two to three times one side, then repeat
on opposite side.
To break up congested energy at any body part: Make a claw with hands and fingers. Move “claw” in gentle
Combing combing movements 2 to 4 inches away from body,
starting from top down, moving the “combing claw” to end
of extremity or body (e.g., anxiousness in stomach: start
just above stomach and move combing claw down across
stomach, over legs, and off feet; repeat until patient feels relief
of stomach stress).
To calm over-energized triple warmer meridian to reduce See Figure for relaxing triple warmer meridian.
stress, anxiety, or pain

Medicine with David Feinstein, which has been blocked from stress by apply- CONCLUSION
is translated in 18 languages. Her or- ing light touch to an acupoint or hold- CAIM modalities have proven to
ganization, Innersource (2017), pro- ing the palm of the hand over specific provide positive benefits to patients
vides online resources and certification acupoints and neurovascular points who experience a variety of symptoms
in energy medicine. Methods in Eden for a few minutes (Eden, 2008). Other often seen in SUDs, including stress,
Energy other than acupressure and HT strategies include quick stress-relieving anxiety, depression, and pain (Au et
have not been studied in research but energy medicine maneuvers such as the al., 2015; Bauer, Tilburt, Sood, Li, &
are widely practiced based on anecdotal zip-up, in which an imaginary zipper Wang, 2017; Church & Feinstein,
evidence. Methods include stimulation is used to zip up the central meridian 2017; Clond, 2016; Gaesser & Karan,
of meridians and holding, tapping, or to protect the individual from nega- 2017; Goldberg et al., 2016; Hen-
rubbing acupoints and neurovascular tive energy, and the mellow mudra, dricks & Wallace, 2017; Weerasinghe
reflex points, which are easy to learn in which fingers are pulled across the & Bartone, 2016). Several methods
and quick to apply, producing rapid forehead to release negative energy of CAIM are easy to learn and can
results in relieving stress or anxiety, (Table 1). These energy exercises are be implemented by nurses and pa-
promoting balance and a sense of well- thought to balance the triple warmer tients, including mindful meditation,
being (Eden, 2008). In Eden Energy meridian and pull stress from the body, acupressure, tapping, EFT, and other
techniques, specific acupoints are ac- balance hormones, and promote relax- healing energy strategies. Although
tivated to release the good energy that ation (Harris, 2015). some evidence supports many CAIM

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Substance Use & Related Disorders

TABLE 2
ONLINE RESOURCES FOR ENERGY HEALING MODALITIES

Method/Modality of
Energy Healing Purpose Online Video Resource
Emotional Freedom Technique Tapping to relieve unwanted [Link]
emotion
Healing Touch Sending healing energy to [Link]
another through the hands (Part 1)
[Link]
(Part 2)
Energy Medicine Self-care for trauma, stress/anxiety [Link]
release (Trauma/Stress)
[Link]
(Stress/Anxiety)
[Link]
(Daily Energy Routine)

TABLE 3
PROFESSIONAL ORGANIZATIONS FOR CERTIFICATION IN ENERGY HEALING
Modality Certifying Organization URL
Healing Touch Healing Touch Program™ [Link]
Emotional Freedom Technique (EFT) EFT Universe [Link]
Association for Comprehensive Energy [Link]
Psychology
Energy Medicine Eden Energy Medicine [Link]
Holistic Nurse Certification American Holistic Nurses Association [Link]

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