New York City Council President Stein's office designated $181,000 of fiscal 1989 to establish a unique pre-natal substance abuse program at Lincoln Hospital. The pregnant substance abuser is treated initially for addiction as the primary problem. She receives acupuncture, counseling, urine testing, using the regular protocol. Education about pregnancy and delivery, pelvic examination and more stressful testing will be conducted as the patient seems ready to handle these matters. City Controller Harrison Goldin has designated $110,000 in the fiscal 1990 budget to develop a parent education program in conjunction with our post-partum program. The Department of health will help us track long-term follow-up for these patients as well as our whole post-partum case load.


AIDS PREVENTION

As we have indicated, acupuncture detoxification is a popular and safe method of relieving stress and craving in a wide range of substance abusers. More than 60% of clients are retained in acupuncture treatment, a much higher figure than any other form of outpatient drug-free treatment. No other drug abuse program except for Lincoln has ever been able to accept poly-drug abusers and mentally ill chemical abusers on an unscreened walk-in basis so that 10 new patients daily can receive acceptable treatment on the day of admission. Lincoln Hospital has a long history of being able to reach the unreachable patient -- including some homicidal, paranoid, and bizarrely psychotic persons who would be rejected in many sites due to the perception of risk of violence. The following patient summaries indicate the capability of an acupuncture program to reach "unreachable" clients. The patient described is typical of the segment of AIDS patients who will be most difficult to relate to and therefore will be more likely to spread the condition.

H.W. came to our clinic with a narcotic and cocaine habit and an obviously paranoid condition. He had a history of LSD psychosis in 1972 and at least 3 state psychiatric hospitalizations. H.W. was evidently hearing voices and reported bizarre somatic delusions. H.W. attended acupuncture 5-6 days a week for the next six months. After the first day he said that his voices "went away." Use of heroin and cocaine continued intermittently. H.W. was so guarded that no individual verbal sessions were attempted until six months later. H.W. is now readily communicative, working part-time and attends acupuncture weekly.

Involving the HIV(+) or PWA person in drug abuse treatment can be the first step in the overall medical treatment of AIDS and a necessary step in the development of sexual responsibility which will protect spouses from the epidemic. The Health Commissioner Steven Joseph has strongly supported this point of view in previous testimony before the New York City Council. The statistic that is most often cited as an indication of the danger of heterosexual spread of AIDS is the rate of HIV(+) findings in mothers and their babies. These statistics have been used to advocate programs such as methadone maintenance and syringe exchange; programs which relate primarily to male narcotic addicts. Helpig a man use narcotics "safely" will not necessarily help him use sexual precautions with women he is involved with. The use of cocaine and alcohol tends to increase sexual irresponsibility.

Only a program which directly helps young women become drug-free will have a substantial effect on the rate of HIV(+) findings in mothers and children in the special context of widespread infection in New York City. These women can then involve their partners in treatment. One of our patients told me her husband walked with her to the clinic with a baseball bat in case she did anything wrong. From my office window I could see the man standing on the street with a bat. Two weeks later this patient brought her husband into the clinic with her for treatment, saying "he doesn't use drugs, he just wants treatment for nerves." Our patient had made a tremendous accomplishment -- an accomplishment that could have easily been sabotaged by premature confrontation.


MEDICAL-SCIENTIFIC REACTION

We are frequently asked about the reaction of the medical scientific community to our use of acupuncture. I remember my own skepticism and certainly understand a natural reluctance to consider the possibility that acupuncture could be effective for such a serious condition as cocaine addiction.

Dr. Milton Bullock and acupuncturist Paticia Culliton of Hennepin County Medical Center in Minneapolis began to use a placebo protocol to evaluate our Lincoln Hospital acupuncture procedure in 1983. Their first article was published in the Alcoholism journal in June 1987. It showed that 37% of the treatment group responded well to acupuncture as compared to 7% of the placebo group which received non-specific acupuncture points. The Hennepin group has just published a more advanced study in Lancet (June 24, 1989, the prestigious journal of the British Medical Association. Twenty-one of 40 treatment acupuncture patients completed the program compared to 1 of 40 controls. Significant treatment effects persisted at the end of a 6-month follow-up. These studies focus on severe recidivist alcoholics who are very rarely engaged in outpatient management.

Dr. Mindy Fullilove of the University of California at San Francisco is just completing a controlled placebo study using the Lincoln protocol with IV heroin abusers. Dr. Stephen Kendall and his staff at Beth Israel in New York have planned a controlled study using acupuncture in the treatment of addicted babies. Dr. Doug Lipton of the Narcotic Drug Research Institute (NDRI) is presently conducting a controlled placebo study using crack patients at Lincoln Hospital. In the recent submission of large scale AIDS prevention drug abuse treatment grants, acupuncture was the second most common procedure suggested for evaluation.

In a recent legislative meeting in Albany, New York, the chief representative of the Medical Society of New York stated that acupuncture was an important part of the health care field and that physicians were seeking more instructive and more active participation in the acupuncture field.


Relations with the Drug Abuse Treatment Field

I have always supported the position that acupuncture can only be component part of the whole process of drug abuse treatment. Nearly all of the existing acupuncture drug abuse programs were developed within already existing licensed treatment programs. Our enabling legislation in New York State was written by Public Health Commissioner Deborah Prothrow Stith, the state drug abuse agency of Massachusetts has funded four acupuncture-based programs during 1989. Numerous methadone programs have established acupuncture components in order to treat crack abuse and other secondary addictions. In a therapeutic community setting, such as the Phoenix House in London, staff members report that acupuncture helps reduce craving, tension among the clients and that most of the clients participate in the weekly acupuncture sessions.


A SOUTH BRONX CLINIC HAS GAINED WORLD-WIDE RECOGNITION

The Lincoln Hospital acupuncture program has received a great deal of national and international attention. More than 60 clinics in the U.S. and another 25 in Europe, Latin America and Asia have been established explicitly on the model of our clinic in theSouth Bronx. Indeed Lincoln Hospital has become a "mecca" for visitors and journalists. Television networks from Spain, Italy, Brazil, Sweden, Britain, Latin America, Hungary and Japan have filmed our acupuncture drug abuse program.

The National Acupuncture Detoxification Association (NADA) was founded in 1985 by clinicians who wanted to extend the example of the Lincoln hospital experience into other treatment settings. I am the chairperson of NADA. The organizational name also uses the Spanish connotation of "nada," suggesting a no-nonsense, drug-free approach. NADA has conducted many training programs for public institutions and communities in undeveloped areas. It has set standards of certification for acupuncture detoxification specialists that are widely accepted in the substance abuse field.

I have just returned from a United Nations meeting in Spain scheduled to plan community-based treatment programs on a widely diversified basis. In the December 1988 issue of the Bulletin of Narcotics, we described NADA programs on the Sioux reservation, in Katmandu, in La Perla in Puerto Rico, and Lincoln as an example of the effectiveness of this model in difficult socioeconomic settings.

It is easy to be confused by the aggressiveness that many addicts present and to conclude that the main goal should be symptom suppression. In fact, the addict himself takes this approach in the extreme by using sedative narcotics. In contrast, we have derived our approach from Chinese theory of detoxification. In Chinese medicine the lack of calm inner strength is described as "empty fire" (xu huo), because the heat of aggressiveness burns out of control when the calm inner tone is lost. The hostile paranoid climate of communities vulnerable to drugs is a clear example of an energy-depleted condition with empty fire burning out of control.

Our patients seek greater power and control over their lives. Empty fire is the illusion of power -- an illusion that leads to more desperate chemical abuse and senseless violence. Acupuncture is an effective treatment for empty fire. The patient is empowered, but in a soft, easy and long-lasting manner.

Testimony presented Michael O. Smith, MD, DAc, to the Select Committee on Narcotics of the US House of Representatives July 25, 1989