Holistic Therapies for Addiction Part 1: Do They Increase the Chances of Getting and Staying Sober?
Pet therapy, acupuncture, yoga, aquatic therapeutic exercise, homeopathy, equine therapy, art therapy, somatic experiencing, reiki, massage therapy, energy healing, mindfulness/meditation, psychodrama – the list goes on when it comes to holistic offerings at substance use disorder (SUD) treatment facilities, with many claiming a direct relationship with addiction recovery.
One holistic rehab’s “many harmless, natural, and effective methods” include hyperbaric chambers, organic coffee enemas, and exclusive IV drips that allegedly “fire up” natural production of neurotransmitters to heal brain damage caused by heroin abuse.
Fact or Fiction?
I could spend months researching the veracity of claims for holistic therapies, also referred to as integrative or experiential approaches. Do they add anything to the quality of the rehab experience – more importantly, do they increase the chances of getting and staying sober? Could their benefit be in the user’s head – that is, just a placebo effect? Are they worth the added expense? Could some of them be harmful?
Several years ago, I attempted to answer these questions as I researched numerous holistic approaches in an electronic special called “Holistic Rehab Therapies: Are Alternative Addiction Treatments Helpful, Harmless, or Head Games?” This two-part article will provide an update on some of them and also raise general issues about the topic of holistic therapies, which seem to be increasingly popular in SUD treatment.
Where’s the Evidence?
Determining the accuracy of claims made about holistic approaches is difficult. Consider The Addiction and Recovery Guide, a website that greatly stretches the truth by stating:
“Recent scientific studies have demonstrated dramatically improved success rates with the addition of holistic treatment approaches.”
It then goes on to provide links to summaries of a wide array of alternative practices and how they play a role in treating SUDs. Like other addiction-related websites that provide references supporting the use of holistic therapies, they may cite one small study and/or ones published some time ago or in obscure journals. For instance, when this particular site discusses qigong, a series of slow movement exercises believed to have health promoting and healing effects, they describe one small study supporting its use in heroin addiction detox, published more than a decade ago in an alternative therapies journal.
When I see some of the holistic therapies offered by rehabs and claims made supporting them, I wonder how they can get away with such practices. Mark Willenbring, MD, Director of Alltyr Clinic in St. Paul, MN and former director of the Treatment and Recovery Research Division at the National Institute on Alcohol Abuse and Alcoholism pulled no punches when he told me:
“Treatment centers are able to offer just about whatever they want, regardless of whether there’s scientific research or expert consensus concerning effectiveness.”
Here’s a run-down of just a handful of holistic/alternative therapies offered at SUD treatment facilities along with what we know about their efficacy:
A popular addiction list serve for lay people recently quoted an expert as saying that acupuncture has been “extremely helpful for those with substance use disorders,” with benefits including a decrease in cravings, anxiety, and depression among many other benefits. A U.S. college of “Oriental” medicine makes similar claims.
Although there was evidence of effectiveness of needle acupuncture on withdrawal/craving and anxiety, the body of evidence for these results was considered of low to very low quality.-Anne FletcherA 2015 systematic review of the scientific literature published by the Rand Corporation sought to determine the efficacy and safety of acupuncture as an adjunctive (add-on) or “alone” therapy – looking at outcomes including relapse, frequency and quantity of substance use, withdrawal symptoms, treatment dropout, and health-related quality of life – in adults with alcohol, opioid, stimulant, or cannabis use disorders. They compared acupuncture outcomes with those of other types of interventions such as sham acupuncture or treatment as usual, as well as being on a waiting list or no treatment at all.
The authors concluded, “The available evidence suggests no consistent effect of acupuncture versus comparator interventions on substance use outcomes.”
Although there was evidence of effectiveness of needle acupuncture on withdrawal/craving and anxiety, the body of evidence for these results was considered of low to very low quality. There was no evidence that acupuncture caused serious harmful effects, but only 12 of the 41 studies reviewed reported on harm. The bottom line from the reviewers? “The generally poor methodological quality of the body of evidence prevents any strong conclusions about needle acupuncture for substance use disorders.”
- Somatic Experiencing (SE)
Developed as a “psycho-physiological approach” to help people who have post-traumatic stress disorder (PTSD) and/or trauma, SE seemed to be everywhere in addiction treatment when I wrote Inside Rehab. According to SE theory, symptoms arising from a traumatic event come about when leftover energy from the traumatic event is not discharged from the body, remaining trapped in the nervous system, where it can take a physical and psychological toll.
In SE sessions, clients work with a practitioner to learn how to tune in to bodily sensations – such as butterflies in the stomach, tightness in the belly, warmth in the chest, or tightness in the shoulders or legs – that are supposed to enable the release of trapped energy and thereby the old issues.
Apparently, as time goes on in SE therapy, it’s not unusual for the client to start shaking and trembling, referred to as a “discharge” in SE. This is considered to be the release of old-trauma energy from the nervous system, which is supposed to relieve the body of distressing symptoms and help the person.
Does SE have scientific support? At the primary SE website (which lists addiction treatment as one of many healing professions for which SE provides effective skills) only three studies are listed, none of them rigorously designed (nor related to SUDs.) All three are with hurricane or tsunami workers or survivors. In a comprehensive 2010 report on treatment of PTSD issued by the Departments of Veterans Affairs and Defense, SE was not among the evidence-based therapies. In fact, the report concluded, “There is insufficient evidence to recommend the use of any biomedical somatic therapies for first-line treatment of PTSD.”
In a comprehensive 2010 report on treatment of PTSD issued by the Departments of Veterans Affairs and Defense, SE was not among the evidence-based therapies.-Anne FletcherMore recently, when I noticed that a Cochrane review (these are respected reviews of the scientific literature on selected topics) on psychological therapies for PTSD had nothing about somatic experiencing, I asked the lead author why. Professor Jonathan Bisson of the Cardiff University School of Medicine in Wales replied, “We only included randomized controlled trials and I am not aware of any for somatic experiencing.”
Could SE hurt anyone? Who knows since there appears to be no research on adverse outcomes? Rehabs with staff having advanced mental-health degrees seem to be better-equipped to help clients process what might unfold from such unconventional therapies, but many facilities have less sophisticated primary counselors.
- Equine-assisted therapy.
It was hard for me to find a high-end rehab that didn’t use horses for therapy. (The official organization that trains and certifies people to incorporate horses into therapy services is the Equine Assisted Growth and Learning Association [EAGALA]).
Although a prominent addiction researcher scoffed at the list of studies supporting this approach that I showed her when researching Inside Rehab, a 2013 Health Psychology review of “empirical literature in an emerging body of evidence for the effectiveness of biopsychosocial interventions involving equines across populations with chronic illness or health challenges” found some tentatively promising supportive evidence.
Although the researchers located just 14 studies meeting their inclusion criteria and no randomized controlled trials were located, nine studies that did meet their criteria demonstrated statistically significant positive effects. However, the authors concluded that more rigorously designed and long-term future studies are needed. And certainly safety needs to be considered.
- Mindfulness-Based Relapse Prevention Therapy (MBRP)
Mindfulness and its most common practice, meditation, have become so accepted for so many problems –including SUD treatment – that I stopped thinking of it as “alternative” or even “holistic.” Yet I was surprised when I saw the conclusions of a 2015 Rand review of the scientific literature on MBRP, which I reported about in a Pro Talk article about mindfulness.
For substance use outcomes, the authors concluded that there were no consistent differences between MBRP and any of the treatments to which it was compared.-Anne FletcherMBRP was developed by researchers at the Addictive Behaviors Research Center at the University of Washington and incorporates mindfulness-based meditation with relapse prevention techniques. Its goal is to decrease the risk and severity of relapse following treatment.
The Rand review is the only study to systematically review all randomized controlled trials of MBRP. For substance use outcomes, the authors concluded that there were no consistent differences between MBRP and any of the treatments to which it was compared – for instance, standard relapse prevention, cognitive behavioral therapy, or “treatment as usual.”
They stated, “Overall, the available evidence in support of MBRP is very limited, both in terms of the quantity of existing studies and the quality of the body of evidence,” also making the point that the available evidence on adverse effects is very limited. How could mindfulness hurt anyone? An interesting recent article at theguardian.com raised some possibilities.
Clearly, further research is needed, as it is for all holistic/alternative therapies used in addiction treatment.
Part 2 will address general questions and issues one should ask and consider when offered holistic approaches during substance use disorder treatment.
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