A Biochemical Hypothesis for the Effectiveness of Acupuncture in the Treatment of Substance Abuse: Acupuncture and the Reward Cascade

This paper explores the physiological basis of the acupuncture effect in the treatment of addiction and focuses on the relationship of acupuncture to the reward “cascade.” It proposes that the reward cascade combined with endorphin mechanisms may provide the biochemical framework to explain the mechanisms by which acupuncture provides relief from the symptoms of drug withdrawal, aids in the recovery from addiction, and may help prevent recidivism. T HE EFFICACY of acupuncture in the treatment of substance abusers and drug withdrawal has been amply demonstrated to the scientific community. While many still regard acupuncture with skepticism, clinical trials and scientific investigations have proven its effectiveness. 1-4 In fact, acupuncture has become standard proceExcerpts from a paper presented to the 32nd World Congress of Alternative Medicine, Colombo, Sri Lanka, November 27,1994. dure in many detoxification programs worldwide. 1,3,5,6 However, the mechanisms underlying the effectiveness of acupuncture in the treatment of addiction remain relatively obscure. In the following, we offer a possible explanation for this effect, which involves two theories. I. The Endorphin Mechanism Many cite acupuncture's most heralded biochemical action the stimulation of endorphin production as the primary physiological basis for its success in the treatment of substance abuse. Although the natural painkilling neurotransmitter endorphin is best known for its role in analgesia, according to recent research it may also be partially responsible for drug craving and physical withdrawal symptoms. 6-8 It is thought that http://www.acupuncturejournal.com 34 Copyright American Journal of Acupuncture, Vol. 25, No. 1, 1997 when a person's endorphin receptor sites are filled by endogenous opioid peptides (e.g., endorphin, enkephalin), they experience feelings of wellbeing and, therefore, biological craving for addictive substances does not develop. Exogenous opioids, such as morphine and heroin, are endorphin agonists that is, they have an affinity for and stimulate physiologic activity at cell receptors normally stimulated by naturally occurring endogenous opioids. Thus, substitution of endogenous opioids at receptor sites by agonists (again, such as morphine, heroin, and possibly alcohol) produce the same feeling of wellbeing as when the receptor sites are filled by, e.g., enkephalin. This feeling of wellbeing provides positive reinforcement and contributes to the continued abuse. Chronic use of exogenous opiates or alcohol interferes with opiates or alcohol interferes with opioid receptors and through a negative feedback system results in a decrease of opioid peptides. Hence, when exogenous substances attach to opioid receptor sites, the feedback system is, in effect, “short circuited” and the presynaptic neurons receive the message that endogenous opioid transmission is normal, thus resulting in a reduction in the synthesis of those neurotransmitters. 9 When the exogenous substance is withdrawn, the body must once again begin manufacturing the supplanted endogenous opioids. However, during this time there is a net depletion in the amount of opioids in the body. This is in part responsible for the painful withdrawal symptoms associated with drug