ACUPUNCTURE SCIENCE ASSOCIATION Conference 2015 Ludhiana Punjab Title NADA Protocol for addiction treatment in India- In retrospect Authors Suneel Vatsyayan*, Dr. Ajay Vats**, Abstract In the mid-1970s, Michael Smith, a medical doctor at Lincoln Hospital in the South Bronx area of New York, modified an existing system of auricular acupuncture into a simple technique for the treatment of many common drug addictions as an alternative to methadone. This selection of three to five ear points proved to be extremely effective in the treatment of addictions, and became what is now referred to as the “NADA protocol.” Dozens of studies have documented the effectiveness of the NADA protocol as an adjunct treatment. Among the benefits reported by patients and health care providers are: improved retention in drug treatment programs; more optimistic attitudes about detoxification and recovery; reductions in cravings and anxiety; fewer episodes of sleep disturbance; and reduced need for pharmaceuticals. While the NADA protocol is an important component of any detoxification program, it is by no means the only component. The NADA protocol is often used with other treatment modalities, such as counseling, support groups and self-help programs, to increase the overall effectiveness of care. In 1999, NADA protocol was introduced in India under the supervision of Dr. Michael O. Smith with the objective of making barrier free services and well-being issues available across communities. The proposed paper is a journey in retrospect of NADA protocol globally and India in particular. The paper focuses on issues related to addiction treatment, NADA Protocol, its spread globally and how NADA protocol can meet the needs and challenges in the field of addiction treatment & rehabilitation in India. Contact Information Mob.9810594544, nadaindia@gmail.com acudetoxindia@gmail.com *Chairman, Nada India Foundation (www.nadaindia.info) **Chairman, Indian Association of Acupuncture Detoxification Specialist (IAADS) (www.acudetoxindia.com )

1. NADA Protocol for addiction treatment
in India- In retrospect
Suneel Vatsyayan, MSW, ADS, Nada India
Dr. Ajay Vats, PGDACP, ADS, Indian
Association of Acupuncture Detoxification
Specialist

2. National Survey on Extent, Patterns &
Trends Drug Abuse in India: 2004
Sample Size 40,697 males(12-60
year)
Prevalence of current use
Alcohol 21%
Cannabis 3%
Opiates .7%
Poly drug users 22.3%
IDU (ever) .1%
Name Prevalence Dependency Volume
Alcohol 62.5m 16.8% 10.5m
Cannabis 8.7m 25.7% 2.3m
Opiates 2.0m 22.3% .5m

3. Treatment resources available are not
commensurate with the 'burden of work
• The survey not only points to the problem
of India's population having twice the
global (and Asian) average prevalence of
opiate consumption, but also shows that
the treatment resources available are not
commensurate with the 'burden of work'
(number of dependent drug users).

4. The Bio-Psycho-Social Perspective of Drug Abuse
“Health is a state of complete physical, mental and
social well-being and not merely the absence of
disease and infirmity reflects the holistic view of
health most widely accepted today. Even drug abuse
can be considered within this model, as it is a bio-
psycho-social problem.” - WHO

5. Manifestations of Drug Addiction
• Irresistible urge for drug
• Lack of self control
• Change in daily routine of
activities - neglect of personal
appearance & hygiene
• Moody - often subject to
extreme of temper
• Guilt feeling
• Lack of self confidence and
self image
• Inability to take decisions
• Lack of objective perception
• Feeling of loneliness and apathy
• Distortion of interpersonal
relationships
• Association with addict friends
• Deterioration of work
performance
• Propensity for illegal activities

6. Treatment Components
• Detoxification
• Treat Withdrawal
• Prevent Complications
• Correct/Treat Damage Done
– Usually done in hospitals / specialized setting and using medicines.
• Psychotherapy & Counselling
• Individual Therapy
• Family Therapy
• Group Therapy with recovering addicts; as in AA, NA
• Craving Control Techniques
• Behavioral Therapies
• Relaxation and Leisure Time

7. Rehabilitation & After care
Rehabilitation
• Whole person recovery
• Commitment to a drug free life
• Acceptance of higher value
• Adaptation to work and responsibilities
• Social re-integration
• ‘De-addiction’
Usually done in a specialized facility.

8. Rehabilitation & After care
Aftercare
A process designed to maintain the gains made in treatment and rehabilitation
•Offers opportunity to address outstanding issues
•Provides safe environment until support is no longer required.
•Review of treatment gains
•Identifying and handling craving
•New roles and responsibilities
•Healthy social activities
•Non drug using peers and friends
•Solid counselling relationships
•Share to enable care
May be in out-patient setting through communication and self help groups/ ex-
addicts/ volunteers/ professionals.

9. The needs and challenges in the field
of addiction treatment in India
• Demand reduction strategies seek to prevent the onset of drug use, help
drug users break the habit and provide treatment through rehabilitation and
social reintegration.
• A gap between the streets or ‘natural settings’ associated with drug use or
the outreach worker and the threshold of the drug treatment program where
the drug user is expected to arrive committed, ready or interested in
quitting drugs
• Drug treatment that is limited to abstinence and acceptance of the addict
identity has excluded the majority of drug users who are not ready or
interested in quitting drugs or taking on this identity or disease.
Change is process
‘I have a problem’or ‘I think I should quit’or ‘I have to do something about this…
Mixed feeling of ambivalence to commitment for treatment is long journey… and relapses
are part of it.

10. Challenges
• Can we treat a client before assessment and diagnosis are completed so that
the client can be calm and cooperative enough for a useful diagnosis to be
made.
• Confronting about drug use is necessary?
• Can we help a client even while they are in denial about the need for
treatment.
• Can we make a client relax without him losing control.
• Is the treatment to which client may return at any time, especially following
a relapse and still find all the benefits

11. Acupuncture does not confront the
person..
• Dr. Michael Smith has noted that a verbal
exchange is not required, nor is a readiness to
talk with counselors or a willingness to
complete an assessment or fill out a form.
• NADA acupuncture adds a valuable
component to the correction ,rehabilitation
and behavioral health field without any extra
cost.

12. Non verbal…non threatening
Acupuncture is usually non-threatening because it is non-verbal—the person does
not have to explain or justify himself and it does not have to be associated with
labeling or diagnosis, or an expectation that the person be interested in abstinence,
much less drug or alcohol free at the time they are treated.
Acupuncture is useful because it doesn’t revolve around the drug
• The acupuncture allows greater flexibility in treatment approaches because the
worker can step out of the expert role because the approach itself models a more
horizontal relationship: ‘Did you swab your ears and are you ready for a treatment?’
• Acupuncture and all Qi-flow therapies “help the body help itself.” Some of us have
come to appreciate the body’s spontaneous healing potential.

13. NADA Protocol
At three to five designated ear points in each auricle (outer
ear), clinicians trained through NADA apply fine gauge,
sterilized, one-time use stainless steel needles just under the
skin, where they remain for up to an hour while the client (in
most circumstances) relaxes quietly in a comfortable chair.
Ordinarily, groups of clients sit together while undergoing the
treatment.

14. NADA Protocol
The procedure functions as an adjunct to a
comprehensive treatment program offering the
basic therapeutic elements of counseling,
education, family involvement, mutual support
group involvement, supportive health care of
general nature.

15. Benefits of NADA points
• Sympathetic is related to disruption in both sympathetic and
parasympathetic nervous systems; it has a strong analgesic and
relaxant effect on internal organs as it dilates blood vessels.
• Shen Men regulates excitation and inhibition of the cerebral
cortex and can produce sedation; it is used for many
neuropsychiatric disorders.
• Lung is used for analgesia, sweating, and various respiratory
conditions.

16. NADA Points
• Liver addresses symptoms associated with
poor liver functioning, neuralgia, muscle
spasms and inflammation
• Kidney is the strengthening point for
cerebellum, hematopoietic system; the kidneys
and can relieve mental weariness, fatigue and
headaches.

17. The NADA model of recovery
“Not just “giving it away”, but empowering
communities to be self-reliant.”
“If you know something and you know it first, it
has no meaning unless you let go so someone
else knows it...” - Michael O. Smith

18. NADA acupuncture may help facilitate
significant reduction in cravings, depression,
anxiety, anger, body aches/headaches,
concentration, and decreased energy.
(Kenneth, et. al.)
NADA Model

19. Nada in India since 1999
In 1999, NADA protocol was introduced
in India under the supervision of Dr. Michael
O. Smith with the objective of making barrier
free services and well-being issues available
across communities.

20. NADA policies help the acupuncture
profession
• Upgraded role and new income for acupuncturists as supervisors, trainers
and conveners (New Income)
• NADA programs refer appropriate patients to full body acupuncturists
(More patients)
• NADA provides people in general- an opportunity to overcome fear of
needles before he/she approaches acupuncturist… (Higher acceptability of
needle)
• NADA engages a people before he commits or ready for new identity of a
“Patient” (Trust building)
• NADA gives a chance to experience well being

21. ADS = Safe Track record
• American Acupuncture Council: No claims ever filed against ADSes
• Comparison of Acupuncturists and ADSes in New Mexico
• 14 = # Complaints filed against full body acupuncturists 2008 – 2010
• 0 = # Complaints filed against ADSes 2006 -2010
• No verified information available prior to these dates; Source: New Mexico
State Board of Acupuncture and Oriental Medicine

22. Initiating NADA policies
• Allowing NADA outside of the treatment of addictions
• Creating inroads for non-professional allied health
workers & nurses as assistants and helping professionals
like social workers, counselors, psychologists as
Acupuncture detoxification associates
• Allowing clinics and self help groups that are registered
NGO as to provide services

23. Thanks
www.acudetoxindia.com
www.nadaindia.info
www.acudetox.com