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Impact of Acumpucture in the Treatment of Drug Addiction

       The aims and approaches of Chinese medicine are utterly unlike those of Western medicine, which presents a major barrier in attempting to synthesize acupuncture and contemporary American addiction treatment. The radically different nature of the Chinese approach to healing makes many Western observers skeptical of the entire process; others expect a miracle cure that acupuncturists themselves do not promise.     

Does acupuncture work to treat drug addiction?

          Acupuncture is widely accepted by medical professionals in the United States as a safe treatment for chronic pain. Other applications for acupuncture, such as relief of asthma, arthritis, nausea, and morning sickness are being explored by the scientific community. In the case of drug addiction, conclusive scientific evidence of acupuncture's efficacy is scarce.

          A Possible Mechanism Underlying the Effectiveness of Acupuncture in the Treatment of Drug Addiction

Acupuncture, arguably the most well-known alternative medicine treatment, has been an important therapy in Eastern countries for thousands of years. Although introduced relatively recently, acupuncture has gained popularity and greater acceptance as a treatment option in Western countries. In oriental medicine, the human body is considered to be a complex network of intricately related processes played upon by opposing forces (Yin and Yang). Fewer studies have been performed to determine the basic mechanism underlying acupuncture’s effectiveness in reducing dopamine release induced by the drugs.


 

(1)Acupuncture and the Negative Reinforcing Effect of Abused Drugs

(a)Role of the Mesolimbic Dopamine System in Acupuncture


            Although there is a lack of well-controlled experiments investigating the effect of acupuncture on drug abuse, including ethanol, a few studies using animal models have provided evidence that acupuncture can play an important role in reducing negative reinforcing effects of drug. Electro acupuncture at the specific point ST36 effectively reduced the increase in alcohol-drinking behavior and enhanced the striatal dopamine level in rats challenged with immobilization stress. While ethanol has diverse effects in the brain, ethanol has been shown to increase the firing rates of mesolimbic dopamine neurons by modulating GABAA receptors located on GABAergic neurons in the VTA. Ethanol has stimulatory, euphoric, sedation, anxiolytic and muscle relaxant effects. Even though all these diverse effects probably cannot be related to one specific single neurotransmitter, dopamine seems to be involved in most of the effects. During ethanol withdrawal, brain stimulation reward thresholds were elevated compared to pre-drug baseline. [1]


              (b)Acupuncture and Cerebral Endogenous Opioid System


The ‘Incentive-sensitization theory’ proposes that enhanced mesocorticolimbic dopamine neurotransmission is currently recognized as a common target of the dependence-producing properties of opioid, psycho stimulants and alcohol. Previous work has suggested cerebral b-endorphin system may be involved in reward. Additionally, cerebral b-endorphin originates in the arcuate nucleus of the mediobasal hypothalamus and projects to limbic structures such as the VTA and the nucleus accumbens, seems to be responsible for the reinforcing effects of abused drugs. A hypothetical model has been proposed for possible interactions between the endogenous opioid reward system and the release of dopamine from the nucleus accumbens. VTA GABA interneurons connect to VTA dopamine neurons and likely inhibit them. Activation of presynaptic m-opioid receptors on these GABAergic interneurons decreases the firing rate of VTA GABA neurons, leading to an increase in release of dopamine in the nucleus accumbens, whereas presynaptic κ-opioid receptors in the nucleus accumbens directly inhibit dopamine release in the nucleus accumbens. β-endorphin released from fibers ascending from the arcuate nucleus of the hypothalamus stimulates m-receptors in the VTA, thereby disinhibiting VTA dopamine neurons. Also, it activates δ-opioid receptors in the nucleus accumbens. Thus, b-endorphin increases dopamine release in the nucleus accumbens. [2]


(2)Acupuncture and the Positive Reinforcing Effect of Abused Drugs

(a)Role of κ-opioid Receptor in Acupuncture


A number of studies with rats have shown that acupuncture attenuates rewarding effects induced by drugs of abuse. Recent work using injections of selective opioid receptor antagonists has shown that k-receptor may be particularly important for the inhibitory effect of high-frequency Electro-acupuncture on the expression of morphine-induced CPP and cocaine-induced CPP. High-frequency electro-acupuncture increases dynorphin release to interact with k-receptor in brain. A similar observation was obtained in another study in which high frequency electro-acupuncture enhanced the expression of mRNA encoding predynorphin in brain. Recent studies have demonstrated that dynorphin causes the decrease in dopamine release within the nucleus accumbens through an action on k-opioid receptors that are located on presynaptic dopaminergic nerve terminals in this region. Furthermore, behavioral studies reported that k-opioid receptor agonists decrease cocaine and heroin self-administration.

Therefore, it has been suggested that high-frequency Electro-acupuncture stimulation is sufficient to dampen morphine-induced CPP through k-opioid receptor. Roles for enkephalin and dynorphin in the mechanisms underlying the inhibitory effect of electro-acupuncture has been replicated using morphine-induced CPP and reinstatement of extinguished CPP. Preproenkephalin or preprodynorphin mRNA levels in the nucleus accumbens were increased, respectively, in rats shown to suppress morphine-induced CPP and reinstatement of extinguished CPP after low- or high-frequency electro-acupuncture.[3]


(b)Inhibition of Dopamine Release by Acupuncture

        There is evidence that the enhancement of dopamine transmission in the nucleus accumbens induced by all addictive drugs is linked to its reinforcing properties and may be implicated in the development of behavioral sensitization. This persistent phenomenon, referred to by some as sensitization, is thought to play a major role in magnifying the positive-reinforcing properties of a subsequent drug challenge and represent the mechanism, at least in part, underlying the 6 of 10 Acupuncture treatment for drug addiction reinstatement of drug-seeking behavior. Thus, there is lot of interest in gaining a better understanding of how acupuncture works in the brain to influence addictive behaviors. Few studies were designed to investigate the effect of acupuncture on extracellular dopamine levels using in vivo microdialysis and behavioral changes in rats treated by repeated drugs, including morphine and alcohol after drug withdrawal followed by drug challenge. Results showed that systemic challenge with drug produced neurochemical and behavioral sensitization indicating a much larger increase in dopamine and behavioral activity compared to saline-pretreated rats. Most importantly, these results demonstrated that even brief (1 min) acupuncture treatments prevented to a great extent, drug-induced elevation in dopamine levels in the nucleus accumbens and also reduced the amount of drug-induced behavioral hyperactivity.[4]

Clinical trials are currently underway to determine the effectiveness of acupuncture in treating drug addiction. Yet, there are still many unanswered questions about the basic mechanisms of acupuncture. Additional research using animal models is of primary importance in understanding the basic mechanisms of acupuncture. Chronic exposure to drugs of abuse produces a withdrawal state as reflected in increases in brain reward thresholds, and this change in reward threshold appears in be opposite to actions of the drug administered acutely. These opposite proponent and opponent processes during the development of drug addiction may contribute to the intense drug craving experienced by addicts.

Future studies should determine if acupuncture therapy can influence any of the other neurotransmitters (GABA and glutamate) believed to play a role in regulating dopamine release. It would also be interesting to assess the effect of acupuncture on drug reward thresholds in animals trained to self-administer drugs of abuse.


Summary


   Several factors play a key role into the treatment of heroin addiction, such as the genetic factor and environmental factor. The genetic factor is one of the important factors which is included in the heroin addiction therapy. 

    We can also see that high-frequency Electro-acupuncture stimulation is sufficient to dampen morphine-induced CPP through k-opioid receptor in one hand, and in other hand the acupuncture therapy can influence any of the other neurotransmitters (GABA and glutamate). Therefore we believed It would also be interesting to assess the effect of acupuncture on drug reward thresholds in animals trained to self-administer drugs of abuse.

2

References

[1-4]Chae Ha Yang, Bong Hyo Lee and Sung Hoon Sohn. A Possible Mechanism Underlying the Effectiveness of Acupuncture in the Treatment of Drug Addiction. Oxford Journals, 20 Nov 2007.


 

Article By: Guy-Armel BOUNDA
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