John Harvey EdD, LPC, ADS
Martha B. Marshall MA, LPC, ADS
December, 2024
John Harvey EdD, LPC-S, ADS is Founder and Executive Director of Northwest Counseling and Wellness Center (NCWC) in Austin, Texas, co-founder of 5NP Texas advocacy organization. Dr. Harvey has used acu-detox for addiction treatment since 1997 and has been a registered trainer of the protocol since 2001. NCWC has used 5NP (five-needle protocol) as an adjunct to its holistic treatment regimen for over 25 years to assist clients in recovery from substance use disorders and co-occurring diagnoses.
Martha B. Marshall, M.A., LPC, ADS, owner of Wild Basin Wellness in Austin, Texas, co-founder of 5NP Texas advocacy organization. Martha is a holistic mental health counselor in private practice, integrating traditional talk therapy with physical movement and spiritual awareness. She leads workshops for veterans, National Guard, and first responders in Central Texas, teaching about mental health and the mind-body connection using water sports and nature experiences. She has provided acu-detox since 2014.
White Paper December 2024 version
During the 2023 Texas state legislative session, lawmakers voted unanimously to broaden
the use of a five-needle ear acupuncture protocol (5NP) to treat physical, emotional and
psychological stress, trauma, and addictions. The tool helps recipients reduce emotional distress,
feel calmer physically, and experience a sense of confidence and capability. 5NP is a limited
acupuncture protocol that non-acupuncturists can be trained to use. Lawmakers saw 5NP as a
much-needed therapeutic resource to address increases in mental health diagnoses across Texas.
Background
Auricular acupuncture for behavioral health was developed in the early 1970s by Lincoln
Hospital in the Bronx, New York, to combat a heroin epidemic. The procedure involves bilateral placement of acupuncture needles into five specific ear points. These ear points promote
a sense of well-being, stillness, and emotional regulation helpful in mitigating symptoms of acute
and post-acute withdrawal (Carter & Olshan-Permutter, 2015). The procedure’s origin was part
of a community driven effort to assist its afflicted citizens to gain footing into recovery from
addiction as well as easing participants into other treatment services (e.g.: group and individual
counseling). The tool so effectively accomplished this, it was nicknamed ‘acudetox’ for its
predictable and beneficial outcomes in substance abuse treatment. Lincoln Hospital became a
center for training non-acupuncturists to learn the simple procedure and in 1985 a codified
training regimen was established along with a training organization called the National
Acupuncture Detoxification Association (NADA).
The tool gained significant attention when used in the aftermath of the September 11th
attacks in 2001. Because of its proximity to ground zero, Lincoln-trained administrators of
acudetox offered treatments to traumatized survivors and first responders. Acudetox became the
preferred mode of treatment for trauma victims of 9/11, its non-verbal approach worked for. participants who simply did not have the ability nor the desire to verbalize their traumatic
experience (Cooley, 2008). The Veterans Administration began to use acudetox after
engagements in the Middle East treating the trauma of wounded veterans. The VA now uses ear
acupuncture to address symptoms of PTSD, depression, pain, insomnia, addiction, and to
promote general well-being.
Since its origin, the protocol has educated practitioners and recipients about its powerful
effects beyond its limited use for addiction detoxification. In fact, acudetox works with or
without an addiction diagnosis, or any diagnosis at all – a better name for the protocol is now
simply, 5NP or the 5-needle protocol. At its core, 5NP helps establish balance and stability
where lives are unstable. It reaches participants in a subjective manner, safely, non-verbally,
non-pharmaceutically and with few known side effects. 5NP works in spite of doubts or
resistance. The protocol has been used around the world to provide psychological first aid in
conditions of natural and human disasters including earthquakes, civil unrest, hurricanes, and
violence, treating those who have limited access to mental health resources.
In 1999 Texas passed its first ‘acudetox law’ with cautious regulations, allowing nonmedical professionals to use the tool under medical supervision, and only in the context of
addiction recovery. The Texas Medical Board was appointed to issue permits to practitioners
called Acudetox Specialist (ADS). After decades of successful use by ADSs, and years of
advocacy to reduce regulation and the tie to an addiction diagnosis, the 88th legislative session
House Bill 1106 passed the Texas House and Senate healthcare committees with unanimous and
bipartisan support. The floor votes were overwhelmingly in support and the new law was signed
by Governor Greg Abbott and enacted on September 1, 2023.
View the new law here
The most significant aspect of the new law is its provision to treat conditions beyond
addiction. The law now allows the 5-needle protocol to treat conditions of trauma, physical,
emotional and psychological stress, as well as addiction recovery. It expands the list of
professionals allowed to use the protocol, and makes future additions to the acceptable
practitioner list easier with Texas Medical Board approval. Additionally, HB 1106 eliminates
unnecessary burdens of supervision requirements and too-frequent permit renewals placed on
practitioners. Confidence to make these changes is a reflection of the data reporting that no
injury claims have been filed over decades of safe use. The possibilities for this protocol are
endless since no one is immune from the debilitating impact of trauma and stress on our
everyday lives. We can now expand our thinking about 5NP’s therapeutic impact beyond drug
detoxification to promote general health and well-being for all.
Five-Needle Protocol Explained
The ear contains a map of the body, known as reflexology. The microcosm of the ear to
body points was documented by French neurologist Paul Nosier in the 1950’s, and replicated by
Terry Oleson, Ph.D., in the 1980’s as well as recently in his work on polyvagal theory (Nogier,
1972, Oleson, 2013, Oleson 2017). In traditional Chinese medicine the acupuncture points 5NP
treat have holistic properties, meaning they affect physical, mental and emotional/spiritual facets
of health.
The points in order of application include:
- Sympathetic Point, is helpful in reducing symptoms of fight or flight and promoting
aspects of ‘rest and digest’ parasympathetic response. This point helps calm anxiety and
regulate an agitated autonomic nervous system. - Shen Men (meaning spirit gate), is helpful in regulating energy in either a
strengthening or tranquil manner. It helps balance ‘high spirited’ and ‘low spirited’
aspects of function, and strengthens self-awareness and a sense of purpose. - Kidney Point, facilitates this detoxification organ system, thought to be a key purveyor
of wisdom, growth and development. An unbalanced kidney results in fear. - Liver Point, is another detoxification organ system which is a major actor (the
General) in forceful yet benevolent assertion. Imbalance in the liver results in
frustration, anger and rage. - Lung Point, a third detoxification organ system, provides support and regulation to the
whole body – taking in and letting go continuously. Lung helps to manage grief and loss,
also self-esteem and dignity.
Together these five points move and regulate energy, mysteriously and subjectively,
creating calm and balance to help recipients access their own inner-healing potential. That said,
5NP is better experienced than explained. 5NP can be administered in a group setting where
many participants sit together. It brings people into a context of therapeutic touch and the
communal aspect of healing. Group treatment fosters peer support, trust, and collaboration
which are helpful in maintaining long term behavioral change. Needles are inserted for a
minimum of 20 minutes but may be used longer. The cost of supplies per treatment is about $1.
Providing 5NP to administrators and healthcare providers helps manage compassion fatigue and
burnout, fostering a culture of self-care in any healthcare arena.
5NP is a trauma-informed protocol because it promotes empowerment, resilience,
respect, choice, self-care and capability with safe face-to-face involvement (Wolkin, 2018).
Without needing to say a word, participants are able to calm themselves, create a quiet and still
space, and begin to believe in their innate ability to be ‘good enough’ to change.
The 5NP effect is similar to meditation without any prerequisite skill to achieve results.
The protocol straddles Western science in its affiliation with the Texas Medical Board and a
standardized training course, and Eastern healing philosophies reflecting the healing impact and
mystery of nature. 5NP is truly holistic; it helps clinicians and recipients think of potential for
growth rather than a biological deficit to fix, which for some is a new perspective on well-being.
5NP produces evidence that people are more functional than they are led to believe.
Data Tells a Distressing Story
The demand for behavioral health treatment significantly outweighs services in Texas. A
recent Texas mental healthcare analysis indicates a significant and growing gap in mental health
services, particularly in more rural communities (Texas Health and Human Services 2024).
Mental health support is urgent in the education setting. The recent CDC Youth Risk Behavior
Survey data shows nearly 60% of female high school students and 30% of male students reported
persistent sadness or hopelessness in 2021 across the U.S. Sadly, 30% of female students had
seriously considered suicide, an increase of nearly 50% in five years (CDC, 2023). A recent
study of national prescription data shows a sharp increase in antidepressant medications being
prescribed to youth, especially girls. Prescriptions for antidepressants to females ages 12-17 rose
130% since March of 2020 and onset of the Covid pandemic response. This is especially
worrisome since in 2018 the FDA recommended a warning label be placed on all antidepressants
prescribed to child and adolescent populations after placebo-controlled trials showed a doubling
of the risk of suicide in early months of the pharmaceutical use. That warning also
recommended close supervision during early use of these medications. Meanwhile, substance
misuse concerns are going underground and worsening as the population continues to turn to
self-medication (Spencer, et.al., 2022). Further, drug overdoses are up and remain the leading
cause of death among for people under the age of 50 in the United States (CDC, 2022).
5NP Texas is Established
5NP Texas (5NPTexas.com) was created to accompany the law change in the wider
rollout of this tool since September 1, 2023. The 5NP Texas organization offers training to
appropriate individuals, as well as support for them to maintain their medical board permits and
create programming where they serve public health. 5NP Texas advocates for wider and more
creative use of the tool in new settings that need help but may not have heard of such a tool.
5NP Texas seeks to collaborate with many new and varied programs, institutions, medical
practices, education settings and private businesses.
5NP Texas Mission Statement
5NP Texas advocates for the use of a five-needle auricular acupuncture
protocol (5NP) for mental health, and trains qualified individuals to administer it.
5NP Texas respects the innate healing potential of all human beings. Our
program promotes a holistic approach to wellness, honoring current medical
science as well as concepts of spirit, mystery, and energy healing.
5NP Texas works to expand use of the five-needle protocol as a simple, safe,
drug free tool to help heal physical, emotional, and psychological stress, trauma
and addiction. 5NP Texas supports efforts to spread the use of this tool to the
most vulnerable populations and to assist communities and practitioners with
resources to achieve their goals.
References
American Psychiatric Association. (2013). The Diagnostic and Statistical Manual of Mental
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Brooks, M. (2020). Nearly 1 in 5 develop mental illness following COVID-19. Medscape Medical News, November 13. Retrieved from https://www.medscape.com/viewarticle/940922_print
Carter, K. & Olshan-Permutter, M. (2015). Impulsivity and Stillness: NADA, Pharmaceuticals, and Psychotherapy in Substance Use and Other DSM Disorders. Behavioral Sciences
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Centers for Disease Control and Prevention (2023). Youth risk behavior survey, data summary &
trends report. Retrieved from https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBS_Data-Summary-Trends_Report2023_508.pdf
Centers for Disease Control and Prevention (2022). U.S. overdose deaths in 2021increased half as
much in 2020 – but are still up 15%. Retrieved from
https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/202205.htm#print
Cooley, L. (2008). Unimagined bridges. Retrieved from https://www.youtube.com/watch?v=vXBBaZF8JBk (Video)
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Spencer, M. R., Curtin, S. C., & Garnett, M. F. (2022). Alcohol-induced Death Rates in the United States, 2019–2020.
Stuyt, E. B., Voyles, C. A., & Bursac, S. (2018). NADA protocol for behavioral health. Putting tools in the hands of behavioral health providers: the case for auricular detoxification specialists. Medicines, 5(1), 20.
Texas Health and Human Services (2024). All Texas access report. Retrieved from https://www.hhs.texas.gov/sites/default/files/documents/all-texas-access-report-dec-2024.pdf
Whitehouse, (2022). Reducing the economic burden of unmet mental health needs. Retrieved from https://www.whitehouse.gov/cea/written-materials/2022/05/31/reducing-the-economic-burden-of-unmet-mental-health-needs/
Wolkin, A. (2018) Using trauma-informed care to guide emergency preparedness and response. Retrieved from https://blogs.cdc.gov/publichealthmatters/2018/07/trauma-care/