Traditional or conventional evidence-based medicine and therapeutic approaches for treating substance use disorders (SUDs) are somewhat limited in number, and exacerbation or relapse rates remain similar to other chronic disorders at 40% to 60% (National Institute on Drug Abuse, 2014). An additional challenge in treating SUDs is the high rate of co-occurring mental health disorders, including depression, anxiety, and posttraumatic stress disorder (PTSD) (Substance Abuse and Mental Health Services Administration, 2017). Pain is also a common symptom in patients with SUDs during the withdrawal period when substances are not available (Schuckit, 2016). When conventional therapies are ineffective or fail to fully treat a disorder, practices that fall outside the mainstream can be used in addition to conventional medicine, which is described as integrative or alternative medicine (Gerbarg, Muskin, & Brown, 2017).
Initially, the National Institutes of Health center for nonpharmacological therapies was named the Office of Alternative Therapy, but has been changed to the National Center for Complementary and Integrative Health (NCCIH; 2015, 2016). Terminology surrounding these nonconventional treatments varies, but the term complementary alternative and integrative medicine (CAIM) is often used and is reflective of the practices as a whole (Gerbarg et al., 2017). Categories of CAIM modalities include dietary supplements, such as a variety of micronutrients and plant-based or herbal medicines; however, the current article focuses on mind–body medicine, manipulative body practices, and energy therapies that can be used in the treatment of SUDs (Gerbarg et al., 2017).
The best known CAIM modalities used for a variety of conditions, including SUDs, are mind–body interventions (MBIs), such as meditation. Specific strategies of mindful meditation include concentration on or repetition of a word to quiet the mind, and concentrating on thoughts and emotions in the present to reduce negative thoughts and emotions, which can activate an innate capacity for healing (Black, 2014; Montgomery-Dossey & Keegan, 2016; Weerasinghe & Bartone, 2016). Mindfulness-based meditation can be described as a complex process of disciplinary systematic training and deployment of attention and awareness, which has been shown to reduce negative thoughts and emotions and substance use relapse (Black, 2014; Weerasinghe & Bartone, 2016). Four elements common in meditation include (a) a quiet location with few distractions; (b) a comfortable posture; (c) focus of attention on a chosen word or set of words, an object, or the sensations of the breath; and (d) an open attitude of letting distractions come and go without judging them (NCCIH, 2016). Improvement in brain function from MBIs has been documented, including an increase in grey matter concentrations in brain regions involved in learning, memory, self-referral processing, emotion regulation, and perspective (Hölzel et al., 2011). In addition, it has been found that MBIs increase white matter connectivity (Laneri et al., 2016) and decrease the amygdala size, which can promote positive neuroplastic changes and stress reduction (Taren et al., 2015). Systematic literature reviews have shown that MBIs can reduce the consumption and cravings of several substances, including alcohol, cocaine, amphetamine drugs, marijuana, cigarettes, and opiate agents, and restore natural reward processes (Chiesa & Serretti, 2014; Garland, Froeliger, & Howard, 2014).
Manipulative Body Practice and Healing Energy Physiology
Healing energy and healing medicine are broad terms used for CAIM techniques that work with the body's subtle energies for realigning, clearing, and delivering fresh energy for healing and vitality (Feinstein & Eden, 2008; Warber, Bruyere, Weintrub, & Dieppe, 2015). Strategies of manipulative body and healing energy practices focus on interacting with fields within the body that are thought to promote wellness, including meridians and chakras. Meridians are energy pathways that connect to the sympathetic and parasympathetic nervous system and regulate physiological function and balance (Au et al., 2015; Thie & Thie, 2012). There are 12 major meridians that supply organs with body energy flows (Micozzi, 2015). Each meridian energy pathway has a number of different energy points that are recognized as acupoints, which, when stimulated, can improve energetic flow (Zhou & Benharash, 2014). The concept of chakras originated in India, and they are thought to be energy channels and centers within the body that can be interacted with to promote balance (Rostami & Jaami, 2016; Viswanathan & Pinto, 2015). The word chakra comes from the Indian Hindu language of Sanskrit (Thompson, 2016), and means wheel, referring to the seven main energy centers that must be in balance to regulate the flow of energy to promote healing (Rostami & Jaami, 2016; Viswanathan & Pinto, 2015).
Acupressure is a CAIM modality similar to acupuncture, a technique where needles are inserted into the meridian acupoints, which are each numbered to correspond with a body region to stimulate energy flow (Longhurst, 2010; Zhou & Benharash, 2014). In acupressure, those same meridians are stimulated by applying firm yet gentle pressure to the acupoint by the use of fingers or a blunt object to stimulate energy flow (Adams, Eschman, & Ge, 2017; Eden, 2008; Mangione, Swengros, & Anderson, 2017; Micozzi, 2015). When illness, disease, pain, or physical dysfunction are present, the energetic flow through meridians can be disrupted. By application of manual pressure and stimulation of acupoints, the energetic balance can be restored through the meridian, thereby to the body part it serves (Micozzi, 2015; Wagner, 2015). Acupressure applied to specific acupoints along the meridian for a specific length of time is easily learned and can be done for self-care, administered to the patient in the office or hospital bed. One of the most useful acupressure maneuvers for reduction of stress and anxiety reactions is to manipulate a meridian referred to as the triple warmer (also referred to as triple burner), which is thought to be related to aid in metabolizing fluids in the body (Cutler, 2007). Methods for acupressure to the triple warmer meridian for relaxation include holding the specific triple warmer meridian and other acupoints at the same time on one side of the body with one or two fingers for 3 minutes, repeating the same on the opposite side of the body. Meridian acupoints commonly manipulated are triple warmer #10 with stomach #36 and triple warmer #2 with urinary bladder #66 (Eden, 2008; Thie & Thie, 2012) (Figure).
Meridian acupressure sites for triple warmer (TW) relaxation (Eden, 2008; Thie & Thie, 2012).
Note. ST = stomach; UB = urinary bladder.
Reprinted with permission from Innersource.
Although not in abundance, some studies have evaluated the effectiveness of acupressure. In one study on auricular acupressure in patients with SUDs, researchers found that it resulted in a significant decline in the severity of cravings, psychological distress, and drug/alcohol measures (Tian & Krishnan, 2006). In another study, a meta-analysis of randomized controlled trials between 1997 and 2014 was performed comparing acupressure with sham control (Au et al., 2015). Of the studies that met criteria for meta-analysis, all reported positive effects of acupressure treatments in the relief of anxiety (Au et al., 2015). Other researchers studied the National Acupuncture Detoxification Association protocol, which included acupressure in a substance abuse treatment program (Carter, Olshan-Perlmutter, Marx, Martini, & Cairns, 2017). Ear acupressure points were stimulated in participants during their recovery. Study results demonstrated positive outcomes of participants feeling better about themselves as well as improved energy levels and less body aches. Of those who received acupressure, there were more individuals who completed the rehabilitation program and a higher incidence of abstinence from alcohol at 3- and 6-month follow up (Carter et al., 2017).
Emotional Freedom Technique
Another meridian manipulation method is manually applying intermittent pressure to meridian points through tapping on them with the fingertips, which is a method in the Emotional Freedom Technique (EFT) (Church & Feinstein, 2017). In EFT, tapping on meridians is done while experiencing a distressing emotion or thought, which is an exposure component. Use of EFT has been shown to improve outcomes in treatment of SUDs, food cravings, depression, PTSD, and anxiety (Church & Brooks, 2013; Church & Feinstein, 2017; Clond, 2016; Gaesser & Karan, 2017; Stapleton, Sheldon, Porter, & Whitty, 2012). Methods in EFT are easy to learn and can be applied to a variety of situations by tapping on the same meridians used in acupressure while stating the problem that is experienced, such as anxiety, and the desired outcome of freedom from that problem.
Healing Touch (HT) uses the hands and intention to work with what are thought to be subtle energy fields that promote healing and relaxation when balanced (Foley, Anderson, Mallea, Morrison, & Downey, 2016). In HT, one person places his/her hands over another person with or without making contact for 5 to 60 minutes as a way of clearing stagnant energy and delivering healing energy, which has been shown in some studies to decrease stress, anxiety, and pain (Goldberg et al., 2016; Hendricks & Wallace, 2017). In some cases, HT strategies can be performed by oneself. Several HT strategies exist, including holding hands still or making movements above the body over chakras and performing subtle energy clearing by making sweeping or combing movements over the body from head to toe (Foley et al., 2016). Other strategies for reducing pain include the pain drain technique, which entails placing the left hand over an area of pain with the right hand initially placed downward to the earth to drain painful energy. When the pain is released, the left hand is turned upward, and the right hand infuses the painful area with healing energy (Foley et al., 2016). In the pain ridge technique, hands are passed above the individual's body in sweeping motions over an area to reduce pain (Foley et al., 2016).
Eden Energy Medicine is an organization started by Donna Eden, who is self-taught and has been a practitioner of CAIM for more than 30 years (Innersource, 2017). Eden (1998) authored the best-selling book Energy Medicine with David Feinstein, which is translated in 18 languages. Her organization, Innersource (2017), provides online resources and certification in energy medicine. Methods in Eden Energy other than acupressure and HT have not been studied in research but are widely practiced based on anecdotal evidence. Methods include stimulation of meridians and holding, tapping, or rubbing acupoints and neurovascular reflex points, which are easy to learn and quick to apply, producing rapid results in relieving stress or anxiety, promoting balance and a sense of well-being (Eden, 2008). In Eden Energy techniques, specific acupoints are activated to release the good energy that has been blocked from stress by applying light touch to an acupoint or holding the palm of the hand over specific acupoints and neurovascular points for a few minutes (Eden, 2008). Other strategies include quick stress-relieving energy medicine maneuvers such as the zip-up, in which an imaginary zipper is used to zip up the central meridian to protect the individual from negative energy, and the mellow mudra, in which fingers are pulled across the forehead to release negative energy (Table 1). These energy exercises are thought to balance the triple warmer meridian and pull stress from the body, balance hormones, and promote relaxation (Harris, 2015).
Quick Energy Exercises to Relieve Stress and Anxiety and Remove Negative Energy
CAIM modalities have proven to provide positive benefits to patients who experience a variety of symptoms often seen in SUDs, including stress, anxiety, depression, and pain (Au et al., 2015; Bauer, Tilburt, Sood, Li, & Wang, 2017; Church & Feinstein, 2017; Clond, 2016; Gaesser & Karan, 2017; Goldberg et al., 2016; Hendricks & Wallace, 2017; Weerasinghe & Bartone, 2016). Several methods of CAIM are easy to learn and can be implemented by nurses and patients, including mindful meditation, acupressure, tapping, EFT, and other healing energy strategies. Although some evidence supports many CAIM interventions, there is a paucity of evidence for use specifically with patients with SUDs and other mental health disorders; therefore, further research is indicated. Numerous web video tutorials, online resources, trainings, and certifications are available related to CAIM (Table 2 and Table 3). Patients are requesting CAIM therapies when traditional methods fail to fully relieve symptoms or when additional measures are sought to improve or complement treatment. Knowledge of CAIM modalities can help nurses offer their patients alternatives that can lead to improved quality of life.
Online Resources for Energy Healing Modalities
Professional Organizations for Certification in Energy Healing
- Adams, A., Eschman, J. & Ge, W. (2017). Acupressure for chronic low back pain: A single system study. Journal of Physical Therapy Science, 29, 1416–1420. doi:10.1589/jpts.29.1416 [CrossRef]
- Au, D.W., Tsang, H.W., Ling, P.P., Leung, C.H., Ip, P.K. & Cheung, W.M. (2015). Effects of acupressure on anxiety: A systematic review and meta-analysis. Acupuncture in Medicine, 33, 353–359. doi:10.1136/acupmed-2014-010720 [CrossRef]
- Bauer, B.A., Tilburt, J.C., Sood, A., Li, G.X. & Wang, S.H. (2016). Complementary and alternative medicine therapies for chronic pain. Chinese Journal of Integrative Medicine, 22, 403–411. doi:10.1007/s11655-016-2258-y [CrossRef]
- Black, D.S. (2014). Mindfulness-based interventions: An antidote to suffering in the context of substance use, misuse, and addiction. Substance Use & Misuse, 49, 487–491. doi:10.3109/10826084.2014.860749 [CrossRef]
- Carter, K., Olshan-Perlmutter, M., Marx, J., Martini, J.F. & Cairns, S.B. (2017). NADA ear acupuncture: An adjunctive therapy to improve and maintain positive outcomes in substance abuse treatment. Behavioral Sciences, 37(7), 2–13. doi:10.3390/bs7020037 [CrossRef]
- Chiesa, A. & Serretti, A. (2014). Are mindfulness-based interventions effective for substance use disorders? A systematic review of the evidence. Substance Use & Misuse, 49, 492–512. doi:10.3109/10826084.2013.770027 [CrossRef]
- Church, D. & Brooks, A. (2013). The effect of EFT (emotional freedom techniques) on psychological symptoms in addiction treatment: A pilot study. Journal of Scientific Research & Reports, 2, 315–323. doi:10.9734/JSRR/2013/3500 [CrossRef]
- Church, D. & Feinstein, D. (2017). The manual stimulation of acupuncture points in the treatment of post-traumatic stress disorder: A review of clinical emotional freedom techniques. Medical Acupuncture, 29, 194–205. doi:10.1089/acu.2017.1213 [CrossRef]
- Clond, M. (2016). Emotional freedom techniques for anxiety. A systematic review with meta-analysis. Journal of Nervous and Mental Disease, 204, 388–395. doi:10.1097/NMD.0000000000000483 [CrossRef]
- Cutler, N. (2007, October9). The triple burner meridian and therapeutic massage. Retrieved from https://www.integrativehealthcare.org/mt/archives/2007/10/while_most_meri.html
- Eden, D. (2008). Energy medicine: Balancing your body's energies for optimal health, joy and vitality. New York, NY: Tarcher/Penguin.
- Feinstein, D. & Eden, D. (2008). Six pillars of energy medicine: Clinical strengths of a complementary paradigm. Alternative Therapies in Health and Medicine, 14(1), 44–54.
- Foley, M.K., Anderson, J., Mallea, L., Morrison, K. & Downey, M. (2016). Effects of Healing Touch on postsurgical adult outpatients. Journal of Holistic Nursing, 34, 271–279. doi:10.1177/0898010115609486 [CrossRef]
- Gaesser, A.H. & Karan, O.C. (2017). A randomized controlled comparison of emotional freedom technique and cognitive-behavioral therapy to reduce adolescent anxiety: A pilot study. Journal of Alternative and Complementary Medicine, 23, 102–108. doi:10.1089/acm.2015.0316 [CrossRef]
- Garland, E.L., Froeliger, B. & Howard, M.O. (2014). Mindfulness training targets neurocognitive mechanisms of addiction at the attention-appraisal-emotion interface. Frontiers in Psychiatry, 4, 173. doi:10.3389/fpsyt.2013.00173 [CrossRef]
- Gerbarg, P.L., Muskin, P.R. & Brown, R.P. (Eds.). (2017). Complementary and integrative treatments in psychiatric practice. Washington, DC: American Psychiatric Association Publishing.
- Goldberg, D.R., Wardell, D.W., Kilgarriff, N., Williams, B., Eichler, D. & Thomlinson, P. (2016). An initial study using Healing Touch for women undergoing a breast biopsy. Journal of Holistic Nursing, 34, 123–134. doi:10.1177/0898010115585414 [CrossRef]
- Harris, P. (2015). Hormonal health and happiness. Retrieved from http://www.positivehealth.com/article/energy-medicine/hormonal-health-and-happiness
- Hendricks, K. & Wallace, K.F. (2017). Pilot study: Improving patient outcomes with Healing Touch. Advances in Peritoneal Dialysis, 33, 65–67.
- Hölzel, B.K., Carmody, J., Vangel, M., Congleton, C., Yerramsetti, S.M., Gard, T. & Lazar, S.W. (2011). Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Research: Neuroimaging, 191, 36–43. doi:10.1016/j.pscychresns.2010.08.006 [CrossRef]
- Innersource. (2017). About Innersource. Retrieved from http://www.innersource.net/em/about/innersource.html
- Laneri, D., Schuster, V., Dietsche, B., Jansen, A., Ott, U. & Sommer, J. (2016). Effects of long-term mindfulness meditation on brain's white matter microstructure and its aging. Frontiers in Aging Neuroscience, 7, 254. doi:10.3389/fnagi.2015.00254 [CrossRef]
- Longhurst, J.C. (2010). Defining meridians: A modern basis of understanding. Journal of Acupuncture and Meridian Studies, 3, 67–74. doi:10.1016/S2005-2901(10)60014-3 [CrossRef]
- Mangione, L., Swengros, D. & Anderson, J.G. (2017). Mental health wellness and biofield therapies: An integrative review. Issues in Mental Health Nursing, 38, 930–944. doi:10.1080/01612840.2017.1364808 [CrossRef]
- Micozzi, M.S. (2015). Fundamentals of complementary and alternative medicine (5th ed.). St. Louis, MO: Elsevier, Saunders.
- Montgomery Dossey, B & Keegan, L. (2016). Holistic nursing: A handbook for practice (7th ed.). Burlington, MA: Jones & Barlett Learning.
- National Center for Complementary and Integrative Health. (2015). Important events in NCCIH history. Retrieved from http://www.nih.gov/about/almanac/organization/NCCIH.htm
- National Center for Complementary and Integrative Health. (2016). Meditation: In depth. Retrieved from https://nccih.nih.gov/health/meditation/overview.htm#hed3
- National Institute on Drug Abuse. (2014). Drugs, brain, and behavior: The science of addiction. Retrieved from https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery
- Rostami, M. & Jaami, M. (2016). Chakra healing by color clothing. International Journal of Humanities and Cultural Studies, 1, 1299–1309.
- Schuckit, M.A. (2016). Treatment of opioid-use disorders. New England Journal of Medicine, 375, 357–368. doi:10.1056/NEJMra1604339 [CrossRef]
- Stapleton, P., Sheldon, T., Porter, B. & Whitty, J. (2012). A randomized clinical trial of meridian-based intervention for food cravings with six-month follow up. Behaviour Change, 28, 1–16. doi:10.1375/bech.28.1.1 [CrossRef]
- Substance Abuse and Mental Health Services Administration. (2017). Mental and substance use disorders. Retrieved from https://www.samhsa.gov/disorders
- Taren, A.A., Gianaros, P.J., Greco, C.M., Lindsay, E.K., Fairgrieve, A., Brown, K.W. & Creswell, J.D. (2015). Mindfulness meditation training alters stress-related amygdala resting state functional connectivity: A randomized controlled trial. Social Cognitive and Affective Neuroscience, 10, 1758–1768. doi:10.1093/scan/nsv066 [CrossRef]
- Thie, J. & Thie, M. (2012). Touch for health. A practical guide to natural health with acupressure touch (6th ed.). Camarillo, CA: Devorss.
- Thompson, I. (2016, December23). Sanskrit. Retrieved from http://aboutworldlanguages.com/sanskrit
- Tian, X. & Krishnan, S. (2006). Efficacy of auricular acupressure as an adjuvant therapy in substance abuse treatment: A pilot study. Alternative Therapies, 12, 66–69.
- Viswanathan, P. & Pinto, N. (2015). The effects of classical music based chakra meditation on the symptoms of premenstrual syndrome. Retrieved from http://oaji.net/articles/2015/1170-1427964872.pdf
- Wagner, J. (2015). Incorporating acupressure into nursing practice. American Journal of Nursing, 115(12), 40–45. doi:10.1097/01.NAJ.0000475290.20362.77 [CrossRef]
- Warber, S.L., Bruyere, R.L., Weintrub, K. & Dieppe, P. (2015). A consideration of the perspectives of healing practitioners on research into energy healing. Global Advances in Health and Medicine, 4(Suppl.), 72–78. doi:10.7453/gahmj.2015.014.suppl [CrossRef]
- Weerasinghe, S. & Bartone, S. (2016). Mindfulness for addiction recovery: A cognitive disciplinary preventive approach to avoid relapse into substance abuse. Journal of Basic and Applied Sciences, 12, 81–91. doi:10.6000/1927-5129.2016.12.13 [CrossRef]
- Zhou, W. & Benharash, P. (2014). Effects and mechanisms of acupuncture based on the principle of meridians. Journal of Acupuncture and Meridian Studies, 7, 190–193. doi:10.1016/j.jams.2014.02.007 [CrossRef]
Quick Energy Exercises to Relieve Stress and Anxiety and Remove Negative Energy
||Action to Take
|To relieve stress, anxiety, panic attacks: Mellow Mudra sign
||Put index fingers and thumbs together and make the “OK” sign. Place fingers and thumbs at each temple. Lay remaining 3 fingers across forehead lightly and hold. Take deep breaths in through nose and out through mouth for 1 to 5 minutes, or until anxiousness has passed.
|To keep negativity out of one's aura: When faced with a difficult patient or situation; before entering an uncomfortable place or crowd
||Hook up energies: Place middle finger in navel and other middle finger between eyes on forehead. Push in and up, take a few deep breaths in through nose and out through mouth.
Acupoints: Thump kidney meridian on each side of chest just below clavicle five times; then make fist and thump center of sternum, place hands along sides of bottom of ribs and thump or rub deeply.
Zip-Up: Trace central meridian from pubic bone up center of body to top of bottom lip.
|To calm stress reaction: Trace triple warmer backwards to reduce the excess energy it carries
||With one hand to opposite side, start at temples and trace over and behind ears, to shoulder, and down outside of arm to tip of ring finger. Do two to three times one side, then repeat on opposite side.
|To break up congested energy at any body part: Combing
||Make a claw with hands and fingers. Move “claw” in gentle combing movements 2 to 4 inches away from body, starting from top down, moving the “combing claw” to end of extremity or body (e.g., anxiousness in stomach: sta rt just above stomach and move combing claw down across stomach, over legs, and off feet; repeat until patient feels relief of stomach stress).
|To calm over-energized triple warmer meridian to reduce stress, anxiety, or pain
||See Figure for relaxing triple warmer meridian.
Online Resources for Energy Healing Modalities
|Method/Modality of Energy Healing
||Online Video Resource
|Emotional Freedom Technique
||Tapping to relieve unwanted emotion
||<ext-link ext-link-type="uri" xlink:href="https://www.youtube.com/watch?v=wZETUX1dom4" xlink:type="simple" xmlns:xlink="http://www.w3.org/1999/xlink">https://www.youtube.com/watch?v=wZETUX1dom4</ext-link>
||Sending healing energy to another through the hands
||<ext-link ext-link-type="uri" xlink:href="https://www.youtube.com/watch?v=2mAqTTAyXcQ" xlink:type="simple" xmlns:xlink="http://www.w3.org/1999/xlink">https://www.youtube.com/watch?v=2mAqTTAyXcQ</ext-link> (Part 1)
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||Self-care for trauma, stress/anxiety release
||<ext-link ext-link-type="uri" xlink:href="https://www.youtube.com/watch?v=9kSmKzFHNTw" xlink:type="simple" xmlns:xlink="http://www.w3.org/1999/xlink">https://www.youtube.com/watch?v=9kSmKzFHNTw</ext-link> (Trauma/Stress)
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Professional Organizations for Certification in Energy Healing
||Healing Touch Program™
||<ext-link ext-link-type="uri" xlink:href="http://www.healingtouchprogram.com" xlink:type="simple" xmlns:xlink="http://www.w3.org/1999/xlink">http://www.healingtouchprogram.com</ext-link>
|Emotional Freedom Technique (EFT)
||<ext-link ext-link-type="uri" xlink:href="http://www.eftuniverse.com" xlink:type="simple" xmlns:xlink="http://www.w3.org/1999/xlink">http://www.eftuniverse.com</ext-link>
|Association for Comprehensive Energy Psychology
||<ext-link ext-link-type="uri" xlink:href="http://www.energypsych.org" xlink:type="simple" xmlns:xlink="http://www.w3.org/1999/xlink">http://www.energypsych.org</ext-link>
||Eden Energy Medicine
||<ext-link ext-link-type="uri" xlink:href="http://www.innersource.net" xlink:type="simple" xmlns:xlink="http://www.w3.org/1999/xlink">http://www.innersource.net</ext-link>
|Holistic Nurse Certification
||American Holistic Nurses Association
||<ext-link ext-link-type="uri" xlink:href="http://www.ahna.org" xlink:type="simple" xmlns:xlink="http://www.w3.org/1999/xlink">http://www.ahna.org</ext-link>